[Arterial hypertension in the obese--aspects of etiopathogenesis]

Many epidemiological and clinical studies show a strong association between arterial hypertension and obesity. The underlying pathophysiological mechanism is unknown. It is thought that the etiopathogenesis of obesity hypertension is exceptional and in that view hormonal, neural, volume and hemodynamic properties of obesity, as well as salt and/or caloric consumption, are outlined. In this article all these factors are discussed. According to the current hypothesis, hyperinsulinemia which is probably a physiologic adaptation to obesity, plays a key role in the pathogenesis of arterial hypertension. Insulin increases the reabsorption of sodium by means of an immediate effect on the kidney tubules. An increase of sodium in the body leads to hypervolemia and to the elevated blood pressure. Chronic hyperinsulinemia perhaps increases the blood pressure indirectly also by means of the central nervous system, namely, by stimulating the activity of the sympathetics.