Obesity, especially abdominal obesity, has emerged as a global health concern in recent decades. It is now considered not an adverse lifestyle condition but a metabolic disease since it could trigger multiple chronic and acute cardiovascular conditions. Obesity and hypertension (high blood pressure) often complement each other both directly and indirectly and could cause an array of health complications including heart attacks and strokes.
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How does obesity cause hypertension?
The pressure exerted by the cardiac muscles after ventricular contraction to push blood through the arteries is called the afterload of the heart. Choked arteries due to fat deposits and excess body weight can cause the heart to exert more pressure for blood circulation. This causes hypertension.
According to the American Heart Association, systolic blood pressure from 130mm Hg upwards and diastolic pressure from 80mm Hg onwards is considered as stage 1 hypertension.
Lifestyle, genetic factors can cause obesity and hypertension
Both obesity and hypertension can develop because of an unhealthy lifestyle. Dr Brijesh Shrivastava, interventional cardiologist, Rhythm Heart Clinic, Bhopal, says that leading a sedentary lifestyle can lead to not only obesity but also hypertension due to high cholesterol and other internal vascular factors. “People with abdominal obesity are more prone to developing hypertension,” he adds. This is mainly attributed to the deposition of excess visceral fat in the abdomen cavity, especially over the internal organs leading to insulin resistance and cardiovascular issues.
According to Dr Shaival H Chandalia, endocrinologist and diabetologist at Jaslok Hospital, Mumbai, apart from lifestyle factors, genetics also play a role in obesity and hypertension.
The triad of insulin resistance, hypertension and obesity
Insulin resistance is a key risk factor for hypertension, as well as other metabolic conditions such as diabetes and cardiovascular diseases. “Insulin resistance is common in people with obesity due to excess fat tissue in the body,” says Dr Chandalia.
Dr Subi Kharel, the endocrinologist at HAMS Hospital, Nepal, says, hypertension and insulin resistance tend to co-exist in people with obesity; insulin resistance causes diabetes and other cardiovascular conditions responsible for triggering fluctuations in blood pressure.
She also adds that obesity is the leading cause of essential hypertension – blood pressure due to non-medical conditions like obesity and family history.
The obesity effect on the RAAS regulator
Obesity could also cause renal complications which in turn can lead to hypertension. According to a research article published in the American Heart Association’s Journal, obesity and visceral fat deposition could directly contribute to hypertension by affecting the Renin-Angiotensin-Aldosterone (RAAS). RAAS is a protein-hormone enzyme system that plays a major role in blood pressure regulation in the body by monitoring blood volume and sodium retention levels. Compression of kidneys due to excess visceral fat deposition in the central part (abdominal cavity) and the activation of the renal sympathetic nervous system are listed as other factors that lead to an increase in blood pressure in obese people.
According to Dr Shrivastava, in a person without hypertension, when there is a drop in blood pressure, the renin-angiotensin-aldosterone system restores normal blood pressure. However, obesity leads to the overstimulation of the RAAS system and leads to excess secretion of renin, an enzyme that controls blood pressure and maintains healthy levels of sodium and potassium.
The compression of the kidneys under visceral fat is the main reason for the increase in renin secretion. Renin works with other hormones and can cause excess sodium retention and increase the blood volume in the renal arteries. These can result in high blood pressure.
How to manage obesity-induced hypertension
Managing obesity-induced hypertension requires a multi-disciplinary approach that includes lifestyle changes, medication and continuous monitoring and management. According to experts, most obesity-related disorders can be managed with dietary adjustments, regular exercise and adequate sleep. “Once you change your lifestyle, obesity and its complication can be reduced,” says Dr Shrivastava.
Experts suggest some ways to manage obesity-induced hypertension:
- Physical activity: Regular physical activity is essential for maintaining a healthy weight and managing hypertension.
- Healthy eating: A balanced diet is vital in controlling hypertension. Consume less sodium and more fruits, vegetables and whole grains. Limit the consumption of added sugars, trans fats and saturated fats. Experts recommend adopting a DASH (Dietary Approaches to Stop Hypertension) diet to help manage hypertension.
- Sleep management: Chronic sleep deprivation can cause hypertension. Getting enough sleep is essential for overall health and well-being.
- Stress management: High-stress levels can contribute to hypertension. Using stress-management techniques, such as meditation, yoga or other forms of exercise, can help lower blood pressure.
- Medications: If lifestyle changes alone are not sufficient to manage hypertension, medication may be necessary.
- A healthy diet can help control hypertension
- Regular exercise helps lower blood pressure and maintain a healthy weight
- Sleep deprivation can lead to hypertension
- Regular monitoring of blood pressure helps identify changes in hypertension