OBESITY & HYPERTENSION - 'TWO PEAS IN A POD'

There is a global epidemic of obesity and hypertension. These two relatively common disorders derive from a basic underlying pathophysiologic abnormality, like 'two peas in a pod' There is a consensus that obesity predicts the future development of hypertension and that the relationship between blood pressure and body weight is linear independent of gender, age, and socioeconomic status. This brief commentary outlines the pathogenetic mechanisms for the obesity-hypertension association. These mechanisms are likely complex, multifactorial, and polygenic with possible roots in early ontogeny. A unifying hypothesis should integrate food intake and excess (resulting in weight gain) with increased sympathetic nervous activity (resulting in increased blood pressure). The adipokine, leptin, appears well suited to fill that role - its hypothalamic signaling pathways and neurovascular outcomes are therefore explored in some detail. An understanding of these relationships from the perspectives of both epidemiology and pathophysiology is crucial to the management of both disorders - obesity with hypertension - and particularly more so in developing countries that lack the resources to deal with the looming epidemic of atherosclerotic cardiovascular disease.