Obesity-Related Hypertension: Epidemiology, Pathophysiology, and Clinical Management

Size: px
Start display at page:

Download "Obesity-Related Hypertension: Epidemiology, Pathophysiology, and Clinical Management"

Transcription

1 nature publishing group Obesity-Related Hypertension: Epidemiology, Pathophysiology, and Clinical Management Theodore A. Kotchen 1 The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60 70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin angiotensin aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and Obesity is associated with increased morbidity and mortality due to hypertension, diabetes, dyslipidemia, and cardiovascular and renal diseases. 1 3 The prevalence of obesity and obesity-related disease is increasing worldwide. The Centers for Disease Control and Prevention estimated that obesity cost the United States at least $147 billion in Consequently, strategies for preventing and treating obesity have become political as well as health-care issues. Scientific and medical interest in the relationship between obesity and hypertension is reflected in the number of publications related to this topic. The number of English language citations in PubMed for obesity AND hypertension progressively increased from 203 in 1990 to 1,427 in 2009, with most of the increase occurring in the past decade. The purpose of this report is to review information about the epidemiology, pathogenic mechanisms, and strategies for prevention and treatment of obesity-related hypertension. Epidemiology of Obesity and Hypertension In both adults and children, obesity rates have increased over the past several decades in the United States. 4,5 Obesity rates have increased in both genders, and among all racial, ethnic, 1 Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Correspondence: Theodore A. Kotchen Received 6 June 2010; first decision 26 June 2010; accepted 12 July American Journal of Hypertension, Ltd. treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype. Keywords: adipokines; blood pressure; central obesity; hypertension; insulin resistance American Journal of Hypertension, advance online publication 12 August 2010; doi: /ajh and socioeconomic groups. Approximately 68% of US adults are either overweight or obese. 6 Based on National Health and Nutrition Examination Survey data, the prevalence of obesity in was 32.2% among adult men and 35.5% among adult women. 5 Among adults, the prevalence of obesity increases with age in men. The prevalence of obesity among African Americans is ~1.5 times that in whites, and Mexican Americans have an intermediate prevalence. 4 During the past three decades, prevalence rates of childhood and adolescent obesity (body mass index (BMI) >95th percentile for age and sex) have more than doubled in the United States. 7 In 2006, 16.3% of children and adolescents were reportedly obese, 8 and ~32% of children are either overweight or obese. 6 Childhood obesity frequently persists into adulthood, with up to 80% of obese children reported to become obese adults. 9 Among adolescents, the prevalence of obesity is approximately twice as high among African Americans and Mexican Americans than among non-hispanic whites. 7 Because of the increasing prevalence of obesity in the United States, it has been projected that the steady increase in life expectancy during the past two centuries will soon end. 10 However, recent reports from the Centers for Disease Control and Prevention suggest that obesity rates may be stabilizing. 5,11 Obesity rates have remained constant for 5 years in men and closer to 10 years in women and children. The prevalence of obesity is increasing not only in the United States, but also globally. 12,13 Socioeconomic and demographic 1170 November 2010 VOLUME 23 NUMBER AMERICAN JOURNAL OF HYPERTENSION

2 Obesity-Related Hypertension STATE OF THE ART transitions occurring in many developing countries are contributing to the escalation of obesity despite continuing nutritional deficiencies. This double burden poses health and economic challenges in resource-constrained populations. In 1998, the prevalence of obesity in the developing world had increased from 2.3 to 19.6% over a 10-year period. 14 Obesity rates have increased threefold or more since 1980 in the Middle East, the Pacific Islands, Australasia, and China. Additionally, the prevalence of childhood overweight has increased in almost all countries for which data are available. 15 Obesity in the developing world is no longer a disease of higher socioeconomic status groups; the burden of obesity is shifting toward groups with lower socioeconomic status as the country s gross national product increases. 16 The increasing prevalence of obesity is related to urbanization, major changes in the food supply, diet, and a reduction in physical activity. 12,14 In parallel with increasing obesity rates, cardiovascular disease (CVD) mortality is rapidly increasing in developing countries. 17 Between 1990 and 2020, mortality from ischemic heart disease and cerebrovascular disease increased to a considerably greater extent in developing than in developed countries (Table 1). It is projected that by 2020, low- and middle-income countries will contribute 19 million of the annual global mortality of 25 million due to CVD. 12 Cross-sectional and longitudinal studies document an association of blood pressure with body weight and an association of blood pressure increases over time with weight gain, even among lean individuals. 22 However, the association of indices of adiposity with blood pressure is less apparent among hypertensive individuals than among the general population, 23 suggesting that the blood pressure adiposity relationship in hypertensives is modulated by environmental and genetic factors. Nevertheless, obese individuals have a 3.5- fold increased likelihood of having hypertension; 19,24 ) 60% of hypertensive adults are >20% overweight. It has been estimated that 60 70% of hypertension in adults may be directly attributable to adiposity. 19 Possibly related to the increased prevalence of obesity, in US adults the prevalence of hypertension increased from 25.0 to 28.7% between and Between and , the prevalence of both obesity and hypertension increased among all age groups of adults, although percentage increases of both were greatest among young adults (Table 2). Similar to adults, the prevalence of hypertension is threefold higher in obese children than in nonobese children. 26 Blood pressures in children have increased in the past decade, and this may also be attributable, at least in part, to an increased prevalence of overweight. 26,27 Additionally, longitudinal Table 1 Global mortality estimates (in thousands) due ischemic heart disease and cerebrovascular disease, by sex, between 1990 and 2020 Ischemic heart disease Women % Increase % Increase Developing countries 1,737 3, ,828 4, Developed countries 1,397 1, ,297 1, Cerebrovascular Disease Developing countries 1,499 3, ,454 3, Developed countries 867 1, Adapted from reference 17. Men Table 2 Age-specific prevalence of hypertension and obesity in the United States at two time periods, and percent increase over time Age (years) Hypertension prevalence (%) Obesity prevalence (%) Percent increase Percent increase > Based on National Health and Nutrition Examination Survey data obtained from reference 25 and the following Centers for Disease Control and Prevention web sites: nchs/nhanes/nhanes /nhanes07_08.htm and Hypertension = systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg, or taking antihypertensive medication. Obesity = body mass index >30 kg/m 2. AMERICAN JOURNAL OF HYPERTENSION VOLUME 23 NUMBER 11 november

3 Obesity-Related Hypertension studies document that weight gain is associated with increases in blood pressure and hypertension incidence. For example, in the Framingham Heart Study, a 5% weight gain was associated with a 20 30% increase in hypertension incidence, and the Harvard Male Alumni study found a weight gain of 25 pounds was associated with a 60% increase in hypertension incidence. 28,29 Visceral obesity or android obesity is in part hormonally determined. Body fat distribution is also affected by environmental and genetic factors. Environmental factors include alcohol intake, cigarette smoking, and the timing of onset of childhood obesity. 30 Most studies suggest that centrally located body fat is a more important determinant of blood pressure elevation than peripheral body fat in both men and women The relationship between waist hip ratio and blood pressure appears to be independent of BMI. 34 Visceral obesity also increases the risks for insulin resistance and dyslipidemia. Further, insulin resistance and obesity are associated with vascular endothelial dysfunction, manifested by endothelium-dependent coronary and peripheral vasodilation. 35,36 Impaired vasoreactivity, which may represent the initiation or early phase in the evolution of atherosclerosis, is more strongly correlated with abdominal obesity than with BMI. 36 The constellation of centripetal obesity (measured as waist circumference), hypertension, insulin resistance, high serum triglyceride concentrations, and low levels of high-density lipoprotein cholesterol constitutes the metabolic syndrome. This syndrome may be heritable, but as shown in the rodent, it may be induced by diets high in simple carbohydrates. 37 In African Americans, we have found that insulin resistance is associated with blood pressure levels and hypertension in men, but not in women, possibly reflecting the difference between android and gynecoid obesity. 38 In children and adolescents, the prevalence of the metabolic syndrome increases with the severity of obesity, and approaches 50% in severely obese youngsters. 39 Although the metabolic syndrome is associated with increased risk of all cause and cardiovascular morbidity and mortality, whether the designation of a syndrome provides more risk information than the individual risk factors by themselves has been questioned Evidence for a genetic contribution to both rare monogenic and to common forms of obesity has recently been reviewed. 43 Most genes that have been found to contribute to the pathogenesis of obesity are expressed in the brain and appear to exert their effects by modulation of feeding behavior. Obesityrelated hypertension may represent a genetically distinct hypertensive phenotype. For example, some genes associated with adiposity may also contribute to the development of hypertension in overweight and obese individuals, e.g., tumor necrosis factor-α, β3-adrenergic receptor, and G-protein β3 subunit. 44 In a relatively isolated French Canadian population, Table 3 Putative mechanisms of obesity-related hypertension Primary mechanisms Sodium retention Increased SNS activity Increased circulating renin angiotensin Increased adipose renin angiotensin Impaired vascular endothelial function Other vascular mechanisms SNS, sympathetic nervous system. Possible underlying mechanisms Antinatriuretic effect of insulin Increased renal SNS activity Increased aldosterone Increased cortisol activity Anatomic renal compression Insulin resistance Renin angiotensin Leptin/other adipokines Obstructive sleep apnea β Adrenergic receptor polymorphisms Psychological stress Increased renal SNS activity Insulin resistance Insulin resistance Altered vascular ion transport in 120 extended families with at least one sib pair affected with early onset hypertension and/or dyslipidemia, a total genome scan identified a cluster of overlapping quantitative trait loci with significant logarithm (base 10) of odds scores on chromosome 1 for the following phenotypes: BMI, fasting insulin, leptin, diastolic blood pressure. 45 Nevertheless, to date, specific genetic factors have not been identified to account for the high heritabilities of hypertension and/or obesity. Pathophysiology of Obesity-Related Hypertension Environmental (e.g.diet content, physical activity, level of stress ), physiological, and genetic factors influence the impact of obesity on arterial pressure. An understanding of the mechanisms of obesity-related hypertension may have important therapeutic implications. The putative physiologic mechanisms of obesity-related hypertension are complex, interdependent, and redundant (Table 3). Sympathetic nervous system Depending on populations studied and methods of measurement, most evidence indicate that sympathetic nervous system activity is increased in obesity, particularly sympathetic activity to the kidney and skeletal muscle, as measured by regional norepinephrine kinetic studies and microneurography, respectively Neural activity to skeletal muscle is more closely related to abdominal visceral fat than to total fat 1172 november 2010 VOLUME 23 NUMBER 11 AMERICAN JOURNAL OF HYPERTENSION

4 Obesity-Related Hypertension STATE OF THE ART mass or abdominal subcutaneous fat. 47 However, hypertension is not an invariable consequence of obesity-related increases of neural activity. Neural activity to the kidney and skeletal muscle is elevated in obese normotensive, as well as in obese hypertensive humans. 46,47 These observations raise the possibility that the impact of obesity-related neural activity on arterial pressure is modified by environmental and genetic factors, including race and gender. For example, muscle sympathetic nerve activity is primarily related to BMI in men, but to blood pressure in women. 49 In Pima Indians, despite a high prevalence of obesity, muscle sympathetic nerve activity is low. 49,50 This may provide a clue for the relatively low prevalence of hypertension in Pima Indians. The causes for activation of the sympathetic nervous system in obesity remain uncertain and may be multiple. 49 Putative mechanisms include hyperinsulinemia and/or insulin resistance; leptin or other adipokines; renin angiotensin; lifestyle factors. Additionally, obesity, especially upper body obesity, is a risk factor for obstructive sleep apnea. Hypertension is causally related to sleep apnea, possibly due to sympathetic outflow as a consequence of intermittent hypoxia. 51 Renal and adrenal mechanisms Obesity-related hypertension is associated with renal sodium retention and impaired pressure natriuresis. 52 Obese humans and subjects with the metabolic syndrome tend to be relatively salt sensitive. 53,54 Increased renal tubular reabsorption of sodium has been attributed to increased sympathetic outflow to the kidney. In the dog, renal denervation blunts sodium retention and attenuates the rise in blood pressure associated with dietary-induced obesity. It has also been suggested that increased intrarenal pressures caused by fat surrounding the kidneys and increased abdominal pressure associated with visceral obesity may impair natriuresis. Impaired pressure-natriuresis may also be related to increased mineralocorticoid activity. We and others have reported that plasma aldosterone is associated with blood pressure, BMI, waist circumference, and insulin resistance Among African Americans, aldosterone is independently associated with hypertension, and plasma aldosterone concentrations are relatively high in African Americans with the metabolic syndrome. 57 These observations suggest that the mineralocorticoid action of aldosterone contributes to obesityrelated hypertension, particularly among African Americans. Consistent with a pathogenic role for aldosterone, the mineralocorticoid antagonist, eplerenone, attenuates sodium retention and hypertension associated with the development of obesity in dogs fed a high-fat diet. 59 Somewhat paradoxically, plasma aldosterone concentrations in obese and hypertensive African Americans are relatively high despite low plasma renin activity. The stimulus for increased aldosterone remains a matter of conjecture, however, recent reports indicate that adipokines may directly stimulate aldosterone production. 60 Although not as potent a mineralocorticoid as aldosterone, in high concentrations, cortisol may increase arterial pressure by activating the mineralocorticoid receptor. Circulating levels of cortisol are variable in obesity; however, they may not reflect cortisol s activity in target tissues β-Hydroxysteroid dehydrogenase type 1 activates cortisone (a functionally inert glucocorticoid) to cortisol (an active glucocorticoid) in target tissues, including adipose tissue. This conversion is more pronounced in visceral than in subcutaneous adipose tissue. 61 The P2-HSD1 mouse with overexpression of HSD1 develops hypertension, features of the clinical metabolic syndrome, and activation of the circulating renin angiotensin aldosterone system. 62 Although these observations are provocative, a role for cortisol in the pathogenesis of obesity-related hypertension and the metabolic syndrome remains to be established. Activation of the renin angiotensin system may also contribute to obesity-related hypertension. Several reports indicate that plasma renin activity and plasma angiotensin II concentrations are elevated in obesity, possibly as a consequence of increased sympathetic outflow to the kidney. 63,64 In obese hypertensive patients, pharmacologic blockade with angiotensin-converting enzymes (ACEs) or angiotensin II receptor blockers ameliorate hypertension and associated metabolic derangements, and reduce the incidence of type 2 diabetes. 65 Additionally, adipose tissue expresses all components of the renin angiotensin system (angiotensinogen, renin, ACE, angiotensin type 1 and type 2 receptors). Preliminary evidence suggests that activation of an adipose renin angiotensin system is associated with high blood pressure in a model of visceral obesity 66,67 and in adipose tissue from obese hypertensive patients. 68 Impaired endothelial function The vascular endothelium plays a major role in the regulation of vascular resistance. Endothelium-derived nitric oxide bioactivation is an important determinant of vascular relaxation. Vascular endothelial dysfunction is associated with a number of cardiovascular risk factors, including obesity, insulin resistance, and hypertension. 35,36 Reduced endothelium-dependent coronary and peripheral arterial vasodilation are more strongly correlated with waist-to-hip ratio than with BMI. Visceral fat, quantified by abdominal computed tomography or ultrasound is independently linked to impaired vasoreactivity. Weight loss improves endothelial function. 69 Adipokines Adipose tissue is increasingly recognized as an endocrine organ with many secretory products. Over 50 different adipocyte-derived substances have been identified, and many AMERICAN JOURNAL OF HYPERTENSION VOLUME 23 NUMBER 11 november

5 Obesity-Related Hypertension of these substances have been implicated in blood pressure control. To date, leptin has been the most thoroughly studied. Leptin is a 167 amino acid peptide that promotes weight loss by reducing appetite and by increasing energy expenditure through sympathetic stimulation to thermogenic tissue. 70 The effects of leptin are primarily mediated by receptors located in the central nervous system. The absence of leptin or a mutation in the leptin receptor induces hyperphagia and obesity in both rodents and humans. Circulating levels of leptin parallel fat cell mass. Blood pressure and leptin are modestly correlated in normotensive and hypertensive individuals after adjustment for fat mass. 71 Two prospective studies have reported that plasma leptin concentration independently predicts the onset of hypertension. 72,73 Although these associations do not necessarily indicate causality, chronic systemic and intracerebral administration of leptin increases blood pressure in rats. 71 Transgenic mice overexpressing leptin develop hypertension, despite weight loss, and conversely, blood pressure is not increased in the obese, leptin deficient ob/ob mouse 71 or in obese, leptin deficient humans. 74 Increased sympathetic outflow is a putative mechanism by which leptin may increase arterial pressure. Leptin activates the sympathetic nervous system both by centrally mediated effects on the hypothalamus and by local peripheral actions. 75 In humans, results of studies of the association of plasma leptin with skeletal muscle nerve activity (measured by peroneal nerve microneurography) are conflicting. High circulating levels of leptin reportedly account for much of the increase in renal sympathetic tone observed in obese human subjects. 76 Because obesity is almost invariably associated with leptin resistance, it has been postulated that the resistance to the weight-reducing effect of leptin is selective, and does not extend to leptin s potential sympathetic and cardiovascular actions. Although acute infusion of leptin produces natriuresis in normotensive rats, the natriuretic effect is attenuated in hypertensive and obese Zucker rats, possibly as a consequence of leptin resistance. 77 Preliminary evidence suggest that other adipocyte- derived peptides may also affect arterial pressure. Circulating adiponectin levels are decreased in obesity-induced insulin resistance, 70 and some studies suggest that adiponectin is protective against hypertension through an endothelial- dependent mechanism. 78 A positive relationship between resistin and hypertension has recently been described. Insulin resistance Insulin resistance may be a link between obesity and hypertension. Obesity is associated with resistance to insulin-stimulated glucose uptake and hyperinsulinemia, and weight loss increases insulin sensitivity. 37 Independent of obesity, centripetal distribution of body fat is associated with insulin resistance and blood pressure. A metabolic consequence of insulin resistance is an impaired capacity of postprandial hyperinsulinemia to suppress lipolysis, resulting in greater free fatty acid release, particularly in upper body/visceral obesity compared with the nonobese or lower body obesity. Release of free fatty acids due to excess adipose tissue lipolysis in upper body obesity contributes to the metabolic abnormalities and possibly to the vascular dysfunction associate with upper body obesity. 30 Experimental evidence suggests that systemic free fatty acids, derived primarily from subcutaneous adipose tissue, may mediate hypertensive mechanisms attributed to insulin resistance. However, many of these studies have been conducted at supraphysiologic concentrations of free fatty acids, and consequently these observations should be considered tentative. Whether hypertension is causally related to insulin resistance and/or hyperinsulinemia remains an unresolved issue. In several rodent models of experimental hypertension, hypertension can be ameliorated or prevented by chemically diverse agents that increase insulin sensitivity or have a primary lipidlowering effect (e.g., thiazolidinediones, metformin, clofibrate, lovastatin). 79 Putative mechanisms by which insulin resistance and/or hyperinsulinemia may increase blood pressure include an antinatriuretic effect of insulin, increased sympathetic nervous system activity, augmented responses to endogenous vasoconstrictors, altered vascular membrane cation transport, impaired endothelium-dependent vasodilatation, and stimulation of vascular smooth muscle growth by insulin. Clinical Management Lifestyle interventions for treatment of obesity include emphasis on nutrition, physical activity, and behavior modification. The increasing prevalence of obesity, including childhood obesity, has stimulated interest in developing and evaluating strategies for obesity prevention. Effective strategies for preventing and controlling overweight and obesity over a short term have been implemented in worksite settings. These interventions have combined instruction in healthier eating with a structured approach to increasing physical activity in the workplace. 80 Interventions for preventing obesity in children have recently been reviewed. 81 Nineteen of 22 studies included in the review were school/preschool-based interventions. The majority of studies were of short term. Nearly all studies resulted in some improvement in diet and physical activity. Some studies that focused on either diet or physical activity alone, but not in combination, had a small but positive impact on BMI. In two small towns in France, a comprehensive and innovative community-based program to prevent obesity in schoolchildren involved the mayor, teachers, health-care providers, food providers, sports associations, the media, scientists, and various branches of town government. 82 The towns built sporting facilities, playgrounds, mapped out walking itineraries, and hired 1174 november 2010 VOLUME 23 NUMBER 11 AMERICAN JOURNAL OF HYPERTENSION

6 Obesity-Related Hypertension STATE OF THE ART sports instructors. Families were offered cooking workshops and families at risk were offered individual counseling. Between 2000 and 2005, the prevalence of overweight in children had fallen to 8.8%, whereas it had risen to 17.8% in neighboring comparison towns. This total community approach is now being extended to 200 towns in Europe under the name EPODE (Ensemble, prevenons l obesite des enfants (Together, let s prevent obesity in children)). 83 Several different diets have been advocated for the treatment of obesity (e.g., very-low-calorie diets, balanced-deficit diets, low-fat diets, low-carbohydrate diets, high-protein diets), and weight loss occurs with each of them. 84 A number of behavioral strategies, administered either individually or groups, may assist with adherence. As recently reviewed, 83 behavioral packages may include food diaries and activity records, control of stimuli that activate eating, slower rate of eating, goal setting, behavioral contracting and reinforcement, nutrition education, meal planning, social support, cognitive restructuring and problem solving. Incorporation of increased physical activity (e.g., activity that expends ~2,500 kcal/week) in the regimen increases the likelihood of maintaining weight loss. Nevertheless, the recidivism rate is high. Approximately 90% of people who lose weight by dieting regain it within 3 5 years. 85 For patients with BMI >27 kg/m 2 who do not respond to a trial of diet, exercise, and behavior therapy, pharmaco therapy can be tried. Two medications are currently available in the United States for the treatment of obesity: (i) orlistat an inhibitor of pancreatic lipase that reduces intestinal digestion of fat and (ii) sibutramine a serotonin norepinephrine reuptake inhibitor. 84 Orlistat is associated with steatorrhea, and sibutramine may actually increase blood pressure and blunt the decrease associated with weight loss. In adolescents, metformin has recently been shown to cause a small but statistically significant decrease in BMI when added to a lifestyle intervention program. 86 Bariatric procedures are being performed with increasing frequency for patients with BMI >40 kg/m 2 or BMI >35 kg/m 2 with associated comorbidities. 87 In the short term, blood pressure has been shown to decrease in response to orlistat and to bariatric surgery. 88,89 However, hypertension per se is generally not considered an indication for these pharmacologic or surgical approaches. Many predominantly short-term (6-week to 6-month duration) clinical trials document that even moderate weight loss (5 10%) results in reduction of blood pressure and hypertension incidence, and improvement in insulin sensitivity and vascular endothelial function. 36,69 Reviews of randomized trials reported a diastolic reduction of 0.92 mm Hg and a systolic reduction of 1 mm Hg/kg of weight loss. 90 However, review of longer term trials, including trials of bariatric surgery, suggests that the maximum effect of weight loss on blood pressure occurs during and soon after weight loss and that this effect is attenuated in the long term. 91 In addition to weight loss and other lifestyle modifications, many if not most obese, hypertensive patients ultimately require treatment with one or more antihypertensive agents for blood pressure control. There is little clinical trial data to indicate that any one class of agents is superior to others. Most guidelines do not recognize obese patients as a special population, and do not make specific recommendations for the pharmacologic treatment of hypertension associated with obesity. The general principles of pharmacotherapy for obese patients are not different from nonobese patients, but there are a few caveats. The capacity of thiazide diuretics to lower blood pressure in obese hypertensive patients is well established, 92 and the adverse metabolic effects of diuretics (insulin resistance, dyslipidemia, hypokalemia) are dose related. ACE inhibitors, and possibly angiotensin II receptor blockers, increase insulin sensitivity and reduce diabetes risk. 93,94 Some consider ACE inhibitors to be the most appropriate medication for blood pressure control in obese hypertensive patients. 95,96 Although the recent DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) study suggests that the reduction in diabetes risk with ACE inhibition in patients with low cardiovascular risk was not as pronounced as expected, that study did not target an obese hypertensive population. 97 In the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) trial, compared to placebo, blood pressure lowering with perindopril resulted in comparable risk reductions in vascular disease in normal weight, overweight, and obese individuals with a history of stroke. 98 The greatest benefit was observed in those with higher BMIs, possibly because they had higher levels of cardiovascular risk at baseline, including higher blood pressures. The antihypertensive potencies of lisinopril and hydrochlorothiazide were reportedly similar in a study of 223 predominantly white, obese, hypertensive patients. 99 Several trials have documented the efficacy of the combination of hydrochlorothiazide with either an ACE, an ARB, or the renin inhibitor aliskiren in obese hypertensive patients. 100 β-blockers may more effectively decrease blood pressure in obese than in lean hypertensives, perhaps because they decrease cardiac output and plasma renin activity, both of which are increased in obese patients. However, β-blockers may be associated with weight gain and have negative effects on glucose metabolism. 101 The use of β-blockers as first line agents has been questioned because their effect on stroke protection does not compare favorably with other antihypertensive agents. 100 Although calcium antagonists do not have adverse metabolic side effects, and α-blockers have been associated with improved insulin sensitivity and lipid metabolism, there is no compelling reason to use these as first line agents in obesity-related hypertension. AMERICAN JOURNAL OF HYPERTENSION VOLUME 23 NUMBER 11 november

7 Obesity-Related Hypertension In the final analysis, similar to treatment of all hypertensive patients, combinations of agents with complimentary mechanisms may be required to achieve blood pressure goals. Selection of drugs should be individualized, taking into account the severity of hypertension, other CVD risk factors, comorbid conditions, and practical considerations related to cost, side effects, and frequency of dosing. Summary Obesity-related hypertension is a multifactorial phenotype determined by the interaction of genes and environments. However, currently identified genomic factors account for only a small percent of the heritable risk of this phenotype. The association of hypertension with obesity is primarily related to visceral obesity, which in turn is associated with insulin resistance and dyslipidemia. Lifestyle and pharmacologic approaches for treating obesity-related hypertension should address overall CVD risk, not simply hypertension. More work is required to identify culturally sensitive strategies for obesity prevention and their impact not only on body weight, but also on blood pressure, the metabolic phenotypes associated with obesity, and subsequent CVD. Although several mechanisms have been identified that may account for elevated arterial pressure, currently, there is no compelling evidence to indicate that any one class of antihypertensive agents is particularly advantageous for the treatment of obesity-related hypertension. Disclosure: The author declared no conflict of interest. 1. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE. Body weight and mortality among women. N Engl J Med 1995; 333: Corrigan SA, Raczynski JM, Swencionis C, Jennings SG. Weight reduction in the prevention and treatment of hypertension: a review of representative clinical trials. Am J Health Promot 1991; 5: Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L; NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003; 138: Koh HK. A 2020 vision for health people. N Engl J Med 2010; 362: Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, JAMA 2010; 303: Institute of Medicine. Bridging the Evidence Gap in Obesity Prevention: A Framework to Improve Decision Making. National Academy of Sciences; Washington, DC. April Cali AM, Caprio S. Obesity in children and adolescents. J Clin Endocrinol Metab 2008; 93:S31 S Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, JAMA 2008; 299: Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993; 22: Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L, Butler RN, Allison DB, Ludwig DS. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, JAMA 2010; 303: Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008; 93:S Ford ES, Mokdad AH. Epidemiology of obesity in the Western Hemisphere. J Clin Endocrinol Metab 2008; 93:S1 S Popkin BM, Doak CM. The obesity epidemic is a worldwide phenomenon. Nutr Rev 1998; 56: Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006; 1: Monteiro CA, Moura EC, Conde WL, Popkin BM. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ 2004; 82: Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104: Chiang BN, Perlman LV, Epstein FH. Overweight and hypertension. A review. Circulation 1969; 39: Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999; 282: Wilson PW, D Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162: Doll S, Paccaud F, Bovet P, Burnier M, Wietlisbach V. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries. Int J Obes Relat Metab Disord 2002; 26: He J, Klag MJ, Whelton PK, Chen JY, Qian MC, He GQ. Body mass and blood pressure in a lean population in southwestern China. Am J Epidemiol 1994; 139: Kotchen TA, Grim CE, Kotchen JM, Krishnaswami S, Yang H, Hoffmann RG, McGinley EL. Altered relationship of blood pressure to adiposity in hypertension. Am J Hypertens 2008; 21: Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS. Prevalence of obesity, diabetes, and obesity-related health risk factors, JAMA 2003; 289: Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, JAMA 2003; 290: Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension 2002; 40: Muntner P, He J, Cutler JA, Wildman RP, Whelton PK. Trends in blood pressure among children and adolescents. JAMA 2004; 291: Paffenbarger RS Jr, Wing AL, Hyde RT, Jung DL. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol 1983; 117: Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet 2001; 358: Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab 2008; 93:S57 S Blair D, Habicht JP, Sims EA, Sylwester D, Abraham S. Evidence for an increased risk for hypertension with centrally located body fat and the effect of race and sex on this risk. Am J Epidemiol 1984; 119: Kanai H, Matsuzawa Y, Kotani K, Keno Y, Kobatake T, Nagai Y, Fujioka S, Tokunaga K, Tarui S. Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension 1990; 16: Sironi AM, Gastaldelli A, Mari A, Ciociaro D, Positano V, Postano V, Buzzigoli E, Ghione S, Turchi S, Lombardi M, Ferrannini E. Visceral fat in hypertension: influence on insulin resistance and β-cell function. Hypertension 2004; 44: Canoy D, Luben R, Welch A, Bingham S, Wareham N, Day N, Khaw KT. Fat distribution, body mass index and blood pressure in 22,090 men and women in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study. J Hypertens 2004; 22: Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD. Obesity/ insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996; 97: Meyers MR, Gokce N. Endothelial dysfunction in obesity: etiological role in atherosclerosis. Curr Opin Endocrinol Diabetes Obes 2007; 14: O Shaughnessy IM, Kotchen TA. Epidemiologic, physiologic, and clinical implications of hypertension and insulin resistance. Curr Opin Cardiol 1993; 8: november 2010 VOLUME 23 NUMBER 11 AMERICAN JOURNAL OF HYPERTENSION

8 Obesity-Related Hypertension STATE OF THE ART 38. Kidambi S, Kotchen JM, Krishnaswami S, Grim CE, Kotchen TA. Hypertension, insulin resistance, and aldosterone: sex-specific relationships. J Clin Hypertens (Greenwich) 2009; 11: Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: Clemenz M, Kintscher U, Unger T. The metabolic syndrome: cluster with a selffulfilling loop? J Hypertens 2006; 24: Kahn R, Buse J, Ferrannini E, Stern M; American Diabetes Association; European Association for the Study of Diabetes. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005; 28: Sattar N, McConnachie A, Shaper AG, Blauw GJ, Buckley BM, de Craen AJ, Ford I, Forouhi NG, Freeman DJ, Jukema JW, Lennon L, Macfarlane PW, Murphy MB, Packard CJ, Stott DJ, Westendorp RG, Whincup PH, Shepherd J, Wannamethee SG. Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet 2008; 371: Blakemore AI, Froguel P. Is obesity our genetic legacy? J Clin Endocrinol Metab 2008; 93:S51 S Pausova Z, Jomphe M, Houde L, Vezina H, Orlov SN, Gossard F, Gaudet D, Tremblay J, Kotchen TA, Cowley AW, Bouchard G, Hamet P. A genealogical study of essential hypertension with and without obesity in French Canadians. Obes Res 2002; 10: Hamet P, Merlo E, Seda O, Broeckel U, Tremblay J, Kaldunski M, Gaudet D, Bouchard G, Deslauriers B, Gagnon F, Antoniol G, Pausová Z, Labuda M, Jomphe M, Gossard F, Tremblay G, Kirova R, Tonellato P, Orlov SN, Pintos J, Platko J, Hudson TJ, Rioux JD, Kotchen TA, Cowley AW Jr. Quantitative founder-effect analysis of French Canadian families identifies specific loci contributing to metabolic phenotypes of hypertension. Am J Hum Genet 2005; 76: Vaz M, Jennings G, Turner A, Cox H, Lambert G, Esler M. Regional sympathetic nervous activity and oxygen consumption in obese normotensive human subjects. Circulation 1997; 96: Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation 2002; 106: Davy KP. The global epidemic of obesity: are we becoming more sympathetic? Curr Hypertens Rep 2004; 6: Lambert GW, Straznicky NE, Lambert EA, Dixon JB, Schlaich MP. Sympathetic nervous activation in obesity and the metabolic syndrome causes, consequences and therapeutic implications. Pharmacol Ther 2010; 126: Weyer C, Pratley RE, Snitker S, Spraul M, Ravussin E, Tataranni PA. Ethnic differences in insulinemia and sympathetic tone as links between obesity and blood pressure. Hypertension 2000; 36: Friedman O, Logan AG. Sympathoadrenal mechanisms in the pathogenesis of sleep apnea-related hypertension. Curr Hypertens Rep 2009; 11: Hall JE. The kidney, hypertension, and obesity. Hypertension 2003; 41: Rocchini AP, Katch V, Kveselis D, Moorehead C, Martin M, Lampman R, Gregory M. Insulin and renal sodium retention in obese adolescents. Hypertension 1989; 14: Chen J, Gu D, Huang J, Rao DC, Jaquish CE, Hixson JE, Chen CS, Chen J, Lu F, Hu D, Rice T, Kelly TN, Hamm LL, Whelton PK, He J; GenSalt Collaborative Research Group. Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China: a dietary intervention study. Lancet 2009; 373: Goodfriend TL, Egan BM, Kelley DE. Aldosterone in obesity. Endocr Res 1998; 24: Rocchini AP, Katch VL, Grekin R, Moorehead C, Anderson J. Role for aldosterone in blood pressure regulation of obese adolescents. Am J Cardiol 1986; 57: Kidambi S, Kotchen JM, Grim CE, Raff H, Mao J, Singh RJ, Kotchen TA. Association of adrenal steroids with hypertension and the metabolic syndrome in blacks. Hypertension 2007; 49: Bochud VB, Burnier M. The association of aldosterone with obesity-related hypertension and the metabolic syndrome. Semin Nephrol 2007; 27: de Paula RB, da Silva AA, Hall JE. Aldosterone antagonism attenuates obesityinduced hypertension and glomerular hyperfiltration. Hypertension 2004; 43: Willenberg HS, Schinner S, Ansurudeen I. New mechanisms to control aldosterone synthesis. Horm Metab Res 2008; 40: Bujalska IJ, Kumar S, Hewison M, Stewart PM. Differentiation of adipose stromal cells: the roles of glucocorticoids and 11β-hydroxysteroid dehydrogenase. Endocrinology 1999; 140: Masuzaki H, Yamamoto H, Kenyon CJ, Elmquist JK, Morton NM, Paterson JM, Shinyama H, Sharp MG, Fleming S, Mullins JJ, Seckl JR, Flier JS. Transgenic amplification of glucocorticoid action in adipose tissue causes high blood pressure in mice. J Clin Invest 2003; 112: Sharma AM. Is there a rationale for angiotensin blockade in the management of obesity hypertension? Hypertension 2004; 44: Engeli S, Böhnke J, Gorzelniak K, Janke J, Schling P, Bader M, Luft FC, Sharma AM. Weight loss and the renin-angiotensin-aldosterone system. Hypertension 2005; 45: Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensinconverting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 342: Rahmouni K, Correia ML, Haynes WG, Mark AL. Obesity-associated hypertension: new insights into mechanisms. Hypertension 2005; 45: Yasue S, Masuzaki H, Okada S, Ishii T, Kozuka C, Tanaka T, Fujikura J, Ebihara K, Hosoda K, Katsurada A, Ohashi N, Urushihara M, Kobori H, Morimoto N, Kawazoe T, Naitoh M, Okada M, Sakaue H, Suzuki S, Nakao K. Adipose tissuespecific regulation of angiotensinogen in obese humans and mice: impact of nutritional status and adipocyte hypertrophy. Am J Hypertens 2010; 23: Thatcher S, Yiannikouris F, Gupte M, Cassis L. The adipose renin-angiotensin system: role in cardiovascular disease. Mol Cell Endocrinol 2009; 302: Pierce GL, Beske PGL, Lawson BE, Southall KL, Benay FJ, Donato AM, Seals DR. Weight loss alone improves conduit and resistance artery endothelial function in young and older overweight/obese adults. Hypertension 2008; 52: Rasouli N, Kern PA. Adipocytokines and the metabolic complications of obesity. J Clin Endocrinol Metab 2008; 93:S64 S Correia ML, Haynes WG. Obesity-related hypertension: is there a role for selective leptin resistance? Curr Hypertens Rep 2004; 6: Galletti F, D Elia L, Barba G, Siani A, Cappuccio FP, Farinaro E, Iacone R, Russo O, De Palma D, Ippolito R, Strazzullo P. High-circulating leptin levels are associated with greater risk of hypertension in men independently of body mass and insulin resistance: results of an eight-year follow-up study. J Clin Endocrinol Metab 2008; 93: Asferg C, Møgelvang R, Flyvbjerg A, Frystyk J, Jensen JS, Marott JL, Appleyard M, Jensen GB, Jeppesen J. Leptin, not adiponectin, predicts hypertension in the Copenhagen City Heart Study. Am J Hypertens 2010; 23: Ozata M, Ozdemir IC, Licinio J. Human leptin deficiency caused by a missense mutation: multiple endocrine defects, decreased sympathetic tone, and immune system dysfunction indicate new targets for leptin action, greater central than peripheral resistance to the effects of leptin, and spontaneous correction of leptin-mediated defects. J Clin Endocrinol Metab 1999; 84: Mark AL, Agassandian K, Morgan DA, Liu X, Cassell MD, Rahmouni K. Leptin signaling in the nucleus tractus solitarii increases sympathetic nerve activity to the kidney. Hypertension 2009; 53: Eikelis N, Schlaich M, Aggarwal A, Kaye D, Esler M. Interactions between leptin and the human sympathetic nervous system. Hypertension 2003; 41: Villarreal D, Reams G, Freeman RH, Taraben A. Renal effects of leptin in normotensive, hypertensive, and obese rats. Am J Physiol 1998; 275: R2056 R Yiannikouris F, Gupte M, Putnam K, Cassis L. Adipokines and blood pressure control. Curr Opin Nephrol Hypertens 2010; 19: Kotchen TA. Attenuation of experimental hypertension with agents that increase insulin sensitivity. Drug Dev Res 1994; 32: Katz DL, O Connell M, Yeh MC, Nawaz H, Njike V, Anderson LM, Cory S, Dietz W; Task Force on Community Preventive Services. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep 2005; 54: Summerbell CD, Edmunds WE, Kelly SAM, Brown T, Campbell KJ. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2005: CD Romon M, Lommez A, Tafflet M, Basdevant A, Oppert JM, Bresson JL, Ducimetière P, Charles MA, Borys JM. Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes. Public Health Nutr 2009; 12: AMERICAN JOURNAL OF HYPERTENSION VOLUME 23 NUMBER 11 november

9 Obesity-Related Hypertension 83. Westley H. Thin living. BMJ 2007; 335: Bray GA. Lifestyle and pharmacological approaches to weight loss: efficacy and safety. J Clin Endocrinol Metab 2008; 93:S81 S Hill JO. Understanding and addressing the epidemic of obesity: an energy balance perspective. Endocr Rev 2006; 27: Glaser Pediatric Research Network Obesity Study Group. Metformin extended release treatment of adolescent obesity: a 48-week randomized, double-blind, placebo-controlled trial with 48-week follow-up. Arch Pediatr Adolesc Med 2010; 164: Pories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab 2008; 93:S89 S Sharma AM, Golay A. Effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension. J Hypertens 2002; 20: Sjöström CD, Peltonen M, Wedel H, Sjöström L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000; 36: Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003; 42: Aucott L, Poobalan A, Smith WC, Avenell A, Jung R, Broom J. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension 2005; 45: Frohlich ED. Clinical management of the obese hypertensive patient. Cardiol Rev 2002; 10: Scheen AJ. Prevention of type 2 diabetes mellitus through inhibition of the reninangiotensin system. Drugs 2004; 64: Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H; LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: Sharma AM, Pischon T, Engeli S, Scholze J. Choice of drug treatment for obesityrelated hypertension: where is the evidence? J Hypertens 2001; 19: Zanella MT, Kohlmann O Jr, Ribeiro AB. Treatment of obesity hypertension and diabetes syndrome. Hypertension 2001; 38: DREAM Trial Investigators. Effect of ramipril on the incidence of diabetes. N Engl Med 2006; 355: Czernichow S, Ninomiya T, Huxley R, Kengne AP, Batty GD, Grobbee DE, Woodward M, Neal B, Chalmers J. Impact of blood pressure lowering on cardiovascular outcomes in normal weight, overweight, and obese individuals: the Perindopril Protection Against Recurrent Stroke Study trial. Hypertension 2010; 55: Reisin E, Weir MR, Falkner B, Hutchinson HG, Anzalone DA, Tuck ML. Lisinopril versus hydrochlorothiazide in obese hypertensive patients: a multicenter placebo-controlled trial. Treatment in Obese Patients With Hypertension (TROPHY) Study Group. Hypertension 1997; 30: Wenzel UO, Krebs C. Management of arterial hypertension in obese patients. Curr Hypertens Rep 2007; 9: Jordan J, Engeli S, Redon J, Sharma AM, Luft FC, Narkiewicz K, Grassi G; European Society of Hypertension Working Group on Obesity. European Society of Hypertension Working Group on Obesity: background, aims and perspectives. J Hypertens 2007; 25: november 2010 VOLUME 23 NUMBER 11 AMERICAN JOURNAL OF HYPERTENSION

Role of Body Weight Reduction in Obesity-Associated Co-Morbidities

Role of Body Weight Reduction in Obesity-Associated Co-Morbidities Obesity Role of Body Weight Reduction in JMAJ 48(1): 47 1, 2 Hideaki BUJO Professor, Department of Genome Research and Clinical Application (M6) Graduate School of Medicine, Chiba University Abstract:

More information

Diabetes and Obesity. The diabesity epidemic

Diabetes and Obesity. The diabesity epidemic Diabetes and Obesity Frank B. Diamond, Jr. M.D. Professor of Pediatrics University of South Florida College of Medicine The diabesity epidemic Prevalence of diabetes worldwide was over 135 million people

More information

Can Common Blood Pressure Medications Cause Diabetes?

Can Common Blood Pressure Medications Cause Diabetes? Can Common Blood Pressure Medications Cause Diabetes? By Nieske Zabriskie, ND High blood pressure, or hypertension, is a major risk factor for cardiovascular disease. In the United States, approximately

More information

1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME

1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME 1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME Izet Aganović, Tina Dušek Department of Internal Medicine, Division of Endocrinology, University Hospital Center Zagreb, Croatia 1 Introduction The metabolic syndrome

More information

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering

More information

Cardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011

Cardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process

More information

Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007

Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007 Your Life Your Health Cariodmetabolic Risk Syndrome Part VII Inflammation chronic, low-grade By James L. Holly, MD The Examiner January 25, 2007 The cardiometabolic risk syndrome is increasingly recognized

More information

Blood Pressure Classification. Blood Pressure Classification

Blood Pressure Classification. Blood Pressure Classification Blood Pressure Classification Blood Pressure Classification BP Classification SBP mmhg DBP mmhg Normal

More information

Men Sexual Dysfunction Associated with Obesity and Metabolic Syndrome

Men Sexual Dysfunction Associated with Obesity and Metabolic Syndrome Men Sexual Dysfunction Associated with Obesity and Metabolic Syndrome By Aly A. Abbassy, MD, FACE Professor of Medicine (Endocrinology) Alexandria University My Talk will include: 1-Types of Men sexual

More information

Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research?

Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research? Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research? Jody Dushay, MD MMSc Beth Israel Deaconess Medical Center Boston, MA Session 445 No disclosures Disclosure Jody Dushay,

More information

The role of a low sodium diet in the management of hypertension. Dave Glover Consultant Nephrologist, Wrexham

The role of a low sodium diet in the management of hypertension. Dave Glover Consultant Nephrologist, Wrexham The role of a low sodium diet in the management of hypertension Dave Glover Consultant Nephrologist, Wrexham Salt Aims Is it all a bit Woman s Own / Daily Mail? Current guidelines An idea about salt What

More information

Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital

Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital Research Article Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital *T. JANAGAN 1, R. KAVITHA 1, S. A. SRIDEVI

More information

Subject Index. Bariatric surgery, obesity management 134

Subject Index. Bariatric surgery, obesity management 134 Subject Index Acromegaly, PCOS differential diagnosis 149, 150, 154, 155 Adipokines, see specific adipokines Adiponectin, metabolic syndrome role 41 43 Adolescents, PCOS diagnosis 16, 17 Adrenal hyperplasia,

More information

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.

More information

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D.

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D. TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type

More information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and obesity History: A 13-year-old girl is seen for a routine clinic follow-up visit. She has been previously healthy, but her growth curve shows increasing body mass index (BMI) percentiles

More information

Epidemiology of Hypertension 陈 奕 希 3120000591 李 禾 园 3120000050 王 卓 3120000613

Epidemiology of Hypertension 陈 奕 希 3120000591 李 禾 园 3120000050 王 卓 3120000613 Epidemiology of Hypertension 陈 奕 希 3120000591 李 禾 园 3120000050 王 卓 3120000613 1 Definition Hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated. 2 Primary

More information

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients.

Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients. Obstructive sleep apnea and type 2 diabetes Obstructive Sleep Apnea (OSA) may contribute to or exacerbate type 2 diabetes for some of your patients. Prevalence of OSA and diabetes Prevalence of OSA Five

More information

Type 2 Diabetes Media Fact Sheet

Type 2 Diabetes Media Fact Sheet Type 2 Diabetes Media Fact Sheet 1. Type 2 diabetes: Facts & figures 2. What is type 2 diabetes? 3. Risk factors for type 2 diabetes 4. Complications associated with type 2 diabetes 5. The socio-economic

More information

Introduction. Pathogenesis of type 2 diabetes

Introduction. Pathogenesis of type 2 diabetes Introduction Type 2 diabetes mellitus (t2dm) is the most prevalent form of diabetes worldwide. It is characterised by high fasting and high postprandial blood glucose concentrations (hyperglycemia). Chronic

More information

Cardiovascular Disease Risk Factors Part XII Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner September 15, 2005

Cardiovascular Disease Risk Factors Part XII Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner September 15, 2005 Cardiovascular Disease Risk Factors Part XII By James L. Holly, MD Your Life Your Health The Examiner September 15, 2005 As we approach the end of our extended series on cardiovascular disease risk factors,

More information

Body Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ

Body Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ Body Composition & Longevity Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ LONGEVITY Genetic 25% Environmental Lifestyle Stress 75% BMI >30 OBESE 25-30 OVERWEIGHT 18-25 NORMAL WEIGHT 18

More information

Is Insulin Effecting Your Weight Loss and Your Health?

Is Insulin Effecting Your Weight Loss and Your Health? Is Insulin Effecting Your Weight Loss and Your Health? Teressa Alexander, M.D., FACOG Women s Healthcare Associates www.rushcopley.com/whca 630-978-6886 Obesity is Epidemic in the US 2/3rds of U.S. adults

More information

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group Learning Objectives To accurately make the diagnosis of pre-diabetes/metabolic syndrome To understand the prevalence

More information

Weight Loss Surgery DA participants- 18 months later. By: Caitlyn Patrick and Evan Morgan

Weight Loss Surgery DA participants- 18 months later. By: Caitlyn Patrick and Evan Morgan Weight Loss Surgery DA participants- 18 months later By: Caitlyn Patrick and Evan Morgan Outline Background Obesity Comorbidities Treatments Barriers to care Kylee Miller s work PDSA Plan: Systematic follow

More information

DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE

DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE 40 yo woman, BMI 36. Motivated to begin diet therapy. Which of the following is contraindicated: Robert B. Baron MD MS Professor and

More information

TABLE OF CONTENTS. The Cost of Diabesity... 3. Employer Solutions... 4 Provide a Worksite Weight Loss Program Tailored for Diabetes...

TABLE OF CONTENTS. The Cost of Diabesity... 3. Employer Solutions... 4 Provide a Worksite Weight Loss Program Tailored for Diabetes... TH E TABLE OF CONTENTS The Cost of Diabesity... 3 Employer Solutions... 4 Provide a Worksite Weight Loss Program Tailored for Diabetes... 4 Provide Healthy Food Options at the Workplace... 4 Make it Easy

More information

Multiple comorbidities: additive and predictive of cardiovascular risk. Peter M. Nilsson Lund University University Hospital Malmö, Sweden

Multiple comorbidities: additive and predictive of cardiovascular risk. Peter M. Nilsson Lund University University Hospital Malmö, Sweden Multiple comorbidities: additive and predictive of cardiovascular risk Peter M. Nilsson Lund University University Hospital Malmö, Sweden Clinical outcomes: major complications of CVD Heart Attack/ACS

More information

Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.

Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant

More information

Type 1 Diabetes ( Juvenile Diabetes)

Type 1 Diabetes ( Juvenile Diabetes) Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.

More information

An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia

An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia Introduction Executive Summary The International Atherosclerosis Society (IAS) here updates

More information

Do You Know the Health Risks of Being Overweight?

Do You Know the Health Risks of Being Overweight? Do You Know the Health Risks of Being Overweight? U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH WIN Weight-control Information Network What are the risks to my health from

More information

Prevention of Cardiovascular Disease in Children with Diabetes

Prevention of Cardiovascular Disease in Children with Diabetes Prevention of Cardiovascular Disease in Children with Diabetes Stephen R. Daniels, MD, PhD Department of Pediatrics University of Colorado School of Medicine The Children s Hospital Anschutz Medical Campus

More information

Master of Science. Obesity and Weight Management

Master of Science. Obesity and Weight Management Department of Clinical Sciences and Nutrition Master of Science in Obesity and Weight Management Dublin Part-Time Taught Modular Masters Programme Module Descriptor Outlines XN7201 The Obesity Epidemic

More information

Sedentarity and Exercise in the Canadian Population. Angelo Tremblay Division of kinesiology

Sedentarity and Exercise in the Canadian Population. Angelo Tremblay Division of kinesiology Sedentarity and Exercise in the Canadian Population Angelo Tremblay Division of kinesiology Disclosure of Potential Conflicts of Interest Évolution de la pratique d activité physique des adultes canadiens

More information

Type 2 Diabetes Mellitus and Insulin resistance syndrome in Children

Type 2 Diabetes Mellitus and Insulin resistance syndrome in Children Type 2 Diabetes Mellitus and Insulin resistance syndrome in Children Anil R Kumar MD Pediatric Endocrinology MCV/VCU, Richmond VA Introduction Type 2 diabetes mellitus (T2 DM) has increased in children

More information

ADULT HYPERTENSION PROTOCOL STANFORD COORDINATED CARE

ADULT HYPERTENSION PROTOCOL STANFORD COORDINATED CARE I. PURPOSE To establish guidelines for the monitoring of antihypertensive therapy in adult patients and to define the roles and responsibilities of the collaborating clinical pharmacist and pharmacy resident.

More information

By submitting this essay, I attest that it is my own work, completed in accordance with University regulations. Sudhakar Nuti

By submitting this essay, I attest that it is my own work, completed in accordance with University regulations. Sudhakar Nuti 1 HLTH 230: Global Health: Challenges and Responses Professor Richard Skolnik Teaching Fellow: Nidhi Parekh By submitting this essay, I attest that it is my own work, completed in accordance with University

More information

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for

More information

Drug Treatment in Type 2 Diabetes with Hypertension

Drug Treatment in Type 2 Diabetes with Hypertension Hypertension is 1.5 2 times more prevalent in Type 2 diabetes (prevalence up to 80 % in diabetic subjects). This exacerbates the risk of cardiovascular disease by ~ two-fold. Drug therapy reduces the risk

More information

Double Diabetes: Definition, Diagnosis, Treatment, Prediction and Prevention.

Double Diabetes: Definition, Diagnosis, Treatment, Prediction and Prevention. Double Diabetes: Definition, Diagnosis, Treatment, Prediction and Prevention. Professor Paolo Pozzilli University Campus Bio-Medico, Rome Institute of Cell & Molecular Science, Queen Mary, University of

More information

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center

More information

Dietary Composition for Weight Loss and Weight Loss Maintenance

Dietary Composition for Weight Loss and Weight Loss Maintenance Dietary Composition for Weight Loss and Weight Loss Maintenance Bridget M. Hron, MD Instructor in Pediatrics, Harvard Medical School Staff Physician in Gastroenterology & Nutrition and New Balance Foundation

More information

The Influence of Infant Health on Adult Chronic Disease

The Influence of Infant Health on Adult Chronic Disease The Influence of Infant Health on Adult Chronic Disease Womb to Tomb Dr Clare MacVicar Introduction Many diseases in adulthood are related to growth patterns during early life Maternal nutrition important

More information

REVIEW AMELIORATION OF HYPERTENSION IN PATIENTS WITH TYPE 2 DIABETES. William B. White, MD* ABSTRACT INTRODUCTION

REVIEW AMELIORATION OF HYPERTENSION IN PATIENTS WITH TYPE 2 DIABETES. William B. White, MD* ABSTRACT INTRODUCTION AMELIORATION OF HYPERTENSION IN PATIENTS WITH TYPE 2 DIABETES William B. White, MD* ABSTRACT Diabetes and hypertension are 2 of the most potent risk factors for the development of cardiovascular disease,

More information

Section 2. Overview of Obesity, Weight Loss, and Bariatric Surgery

Section 2. Overview of Obesity, Weight Loss, and Bariatric Surgery Section 2 Overview of Obesity, Weight Loss, and Bariatric Surgery What is Weight Loss? How does surgery help with weight loss? Short term versus long term weight loss? Conditions Improved with Weight Loss

More information

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing

More information

Improving cardiometabolic health in Major Mental Illness

Improving cardiometabolic health in Major Mental Illness Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic

More information

Isagenix Clinical Research Summary Suk Cho, Ph.D., Eric Gumpricht, Ph.D., David Despain, M.Sc.

Isagenix Clinical Research Summary Suk Cho, Ph.D., Eric Gumpricht, Ph.D., David Despain, M.Sc. Isagenix Clinical Research Summary Suk Cho, Ph.D., Eric Gumpricht, Ph.D., David Despain, M.Sc. UIC study finds subjects on Isagenix products lost more body fat, lost more visceral fat, showed greater adherence,

More information

Coronary Heart Disease (CHD) Brief

Coronary Heart Disease (CHD) Brief Coronary Heart Disease (CHD) Brief What is Coronary Heart Disease? Coronary Heart Disease (CHD), also called coronary artery disease 1, is the most common heart condition in the United States. It occurs

More information

Diagnosis, classification and prevention of diabetes

Diagnosis, classification and prevention of diabetes Diagnosis, classification and prevention of diabetes Section 1 1 of 4 Curriculum Module II 1 Diagnosis, classification and presentation of diabetes Slide 2 of 48 Polyurea Definition of diabetes Slide 3

More information

Milwaukee School of Engineering Gerrits@msoe.edu. Case Study: Factors that Affect Blood Pressure Instructor Version

Milwaukee School of Engineering Gerrits@msoe.edu. Case Study: Factors that Affect Blood Pressure Instructor Version Case Study: Factors that Affect Blood Pressure Instructor Version Goal This activity (case study and its associated questions) is designed to be a student-centered learning activity relating to the factors

More information

The Primary Prevention of Type 2 Diabetes AADE Practice Synopsis Issued December 1, 2014

The Primary Prevention of Type 2 Diabetes AADE Practice Synopsis Issued December 1, 2014 Introduction The Primary Prevention of Type 2 Diabetes AADE Practice Synopsis Issued December 1, 2014 The prevalence of type 2 diabetes is reaching epidemic proportions with more than 9.3% of adults in

More information

PROCEEDINGS DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT

PROCEEDINGS DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT Diabetic nephropathy affects people with either type 1 or type 2 diabetes mellitus.

More information

An Interview with Gerald Reaven: Syndrome X : The Risks of Insulin Resistance

An Interview with Gerald Reaven: Syndrome X : The Risks of Insulin Resistance An Interview with Gerald Reaven: Syndrome X : The Risks of Insulin Resistance Gerald Reaven, M.D., is Professor Emeritus (Active) of Medicine at Stanford University. He has served as director of the Division

More information

DIABETES AND INSULIN RESISTANCE DIABETES PREVALANCE

DIABETES AND INSULIN RESISTANCE DIABETES PREVALANCE DIABETES AND INSULIN RESISTANCE KARI KOHRS RD LDN CDE UICMC NUTRITION & WELLNESS CENTER DIABETES PREVALANCE Third leading cause of death-- United States 18 million diagnosed Growing at the rate of 3 new

More information

ALPHA (TNFa) IN OBESITY

ALPHA (TNFa) IN OBESITY THE ROLE OF TUMOUR NECROSIS FACTOR ALPHA (TNFa) IN OBESITY Alison Mary Morris, B.Sc (Hons) A thesis submitted to Adelaide University for the degree of Doctor of Philosophy Department of Physiology Adelaide

More information

Obesity and Socioeconomic Status in Children and Adolescents: United States, 2005 2008

Obesity and Socioeconomic Status in Children and Adolescents: United States, 2005 2008 Obesity and Socioeconomic Status in Children and Adolescents: United States, 2005 2008 Cynthia L. Ogden, Ph.D.; Molly M. Lamb, Ph.D.; Margaret D. Carroll, M.S.P.H.; and Katherine M. Flegal, Ph.D. Key findings

More information

Adult Weight Management Training Summary

Adult Weight Management Training Summary Adult Weight Management Training Summary The Commission on Dietetic Registration, the credentialing agency for the Academy of Nutrition and Dietetics Marilyn Holmes, MS, RDN, LDN About This Presentation

More information

Jill Malcolm, Karen Moir

Jill Malcolm, Karen Moir Evaluation of Fife- DICE: Type 2 diabetes insulin conversion Article points 1. Fife-DICE is an insulin conversion group education programme. 2. People with greater than 7.5% on maximum oral therapy are

More information

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications

CHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications CHAPTER V DISCUSSION Background Diabetes mellitus is a chronic condition but people with diabetes can lead a normal life provided they keep their diabetes under control. Life style modifications (LSM)

More information

High Blood Cholesterol

High Blood Cholesterol National Cholesterol Education Program ATP III Guidelines At-A-Glance Quick Desk Reference 1 Step 1 2 Step 2 3 Step 3 Determine lipoprotein levels obtain complete lipoprotein profile after 9- to 12-hour

More information

A 4-year evaluation of blood pressure management in Trinidad and Tobago

A 4-year evaluation of blood pressure management in Trinidad and Tobago Journal of Human Hypertension (1999) 13, 455 459 1999 Stockton Press. All rights reserved 0950-9240/99 $12.00 http://www.stockton-press.co.uk/jhh ORIGINAL ARTICLE A 4-year evaluation of blood pressure

More information

Diabetes mellitus. Lecture Outline

Diabetes mellitus. Lecture Outline Diabetes mellitus Lecture Outline I. Diagnosis II. Epidemiology III. Causes of diabetes IV. Health Problems and Diabetes V. Treating Diabetes VI. Physical activity and diabetes 1 Diabetes Disorder characterized

More information

Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012

Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012 Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012 In 2002, SETMA began a relationship with Joslin Diabetes

More information

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke

More information

Appendix: Description of the DIETRON model

Appendix: Description of the DIETRON model Appendix: Description of the DIETRON model Much of the description of the DIETRON model that appears in this appendix is taken from an earlier publication outlining the development of the model (Scarborough

More information

25-hydroxyvitamin D: from bone and mineral to general health marker

25-hydroxyvitamin D: from bone and mineral to general health marker DIABETES 25 OH Vitamin D TOTAL Assay 25-hydroxyvitamin D: from bone and mineral to general health marker FOR OUTSIDE THE US AND CANADA ONLY Vitamin D Receptors Brain Heart Breast Colon Pancreas Prostate

More information

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 1 Nutrition Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 2 Type 2 Diabetes: A Growing Challenge in the Healthcare Setting Introduction and background of type 2 diabetes:

More information

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College Regulation of Metabolism By Dr. Carmen Rexach Physiology Mt San Antonio College Energy Constant need in living cells Measured in kcal carbohydrates and proteins = 4kcal/g Fats = 9kcal/g Most diets are

More information

The Canadian Association of Cardiac

The Canadian Association of Cardiac Reinventing Cardiac Rehabilitation Outside of acute care institutions, cardiovascular disease is a chronic, inflammatory process; the reduction or elimination of recurrent acute coronary syndromes is a

More information

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic

More information

Cardiovascular Disease Risk Factors

Cardiovascular Disease Risk Factors Cardiovascular Disease Risk Factors Risk factors are traits and life-style habits that increase a person's chances of having coronary artery and vascular disease. Some risk factors cannot be changed or

More information

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections.

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections. National Diabetes Statistics What is diabetes? Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.

More information

Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body.

Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body. International Diabetes Federation Diabetes Background Information Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body.

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

CHEM 1406 BSA/BMI Measurement Laboratory (revised 01/03//06) BSA, Body Surface Area

CHEM 1406 BSA/BMI Measurement Laboratory (revised 01/03//06) BSA, Body Surface Area CHEM 1406 BSA/BMI (revised 01/03//06) BSA, Body Surface Area See pages 105-110 of dosage text for equations, calculations and adult nomogram See pages 270-273 of dosage calculation text for pediatric nomogram

More information

Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment. Bruce Latham, M.D. Endocrine Specialists Greenville Health System

Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment. Bruce Latham, M.D. Endocrine Specialists Greenville Health System Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment Bruce Latham, M.D. Endocrine Specialists Greenville Health System Objectives for this presentation - Understand the thrifty genotype

More information

Body Mass Index Measurement in Schools BMI. Executive Summary

Body Mass Index Measurement in Schools BMI. Executive Summary Body Mass Index Measurement in Schools BMI = BMI weight(kg) {height(m)} 2 Executive Summary Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion

More information

Hypertension and Diabetes

Hypertension and Diabetes Hypertension and Diabetes C.W. Spellman, D.O., Ph.D., FACOI Professor & Associate Dean Research Dir. Center Diabetes & Metabolic Disorders Texas Tech University Health Science Center Midland-Odessa, Texas

More information

Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075

Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075 Title: Protein Intake in Potentially Insulin Resistant Adults: Impact on Glycemic and Lipoprotein Profiles - NPB #01-075 Investigator: Institution: Gail Gates, PhD, RD/LD Oklahoma State University Date

More information

ECONOMIC COSTS OF PHYSICAL INACTIVITY

ECONOMIC COSTS OF PHYSICAL INACTIVITY ECONOMIC COSTS OF PHYSICAL INACTIVITY This fact sheet highlights the prevalence and health-consequences of physical inactivity and summarises some of the key facts and figures on the economic costs of

More information

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012 Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced

More information

Title: Sleep And Weight Control: Exploring the Science Behind the Clinical Observation.

Title: Sleep And Weight Control: Exploring the Science Behind the Clinical Observation. Title: Sleep And Weight Control: Exploring the Science Behind the Clinical Observation. Author: Dr. Charles H. Samuels, MD, CCFP, DABSM Introduction: Chronic sleep restriction or sleep deprivation is a

More information

Endocrine Responses to Resistance Exercise

Endocrine Responses to Resistance Exercise chapter 3 Endocrine Responses to Resistance Exercise Chapter Objectives Understand basic concepts of endocrinology. Explain the physiological roles of anabolic hormones. Describe hormonal responses to

More information

Effects of macronutrients on insulin resistance and insulin requirements

Effects of macronutrients on insulin resistance and insulin requirements Effects of macronutrients on insulin resistance and insulin requirements Dr Duane Mellor RD Assistant Professor in Dietetics, The University of Nottingham, UK Outline of Discussion Issues of determining

More information

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Overview of Diabetes Management By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Objectives: Describe the pathophysiology of diabetes. From a multiorgan systems viewpoint. Identify the types of diabetes.

More information

Dose-Response Effects of Sodium Intake on Blood Pressure

Dose-Response Effects of Sodium Intake on Blood Pressure I Dose-Response Effects of Sodium Intake on 1 +2 NS +1 NS -2 NS +5 NS 0.46 (20) 4.6 () 25.9 (1128) FIGURE I-1 Blood pressure (mm Hg) according to dietary sodium intake in g/d (mmol/d) among 8 normotensive

More information

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care This advice has been developed to help GPs with shared care of patients with Non- Alcohol

More information

EXPLORING THE INTERACTION BETWEEN EXERCISE AND MEDICATION FOR CHRONIC DISEASE: CONSIDERATIONS FOR FITNESS PROFESSIONALS

EXPLORING THE INTERACTION BETWEEN EXERCISE AND MEDICATION FOR CHRONIC DISEASE: CONSIDERATIONS FOR FITNESS PROFESSIONALS EXPLORING THE INTERACTION BETWEEN EXERCISE AND MEDICATION FOR CHRONIC DISEASE: CONSIDERATIONS FOR FITNESS PROFESSIONALS Steven T. Johnson, PhD 1 Introduction The prevalence of chronic diseases like cardiovascular

More information

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 WEIGHT LOSS SURGERY Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 EDUCATIONAL OBJECTIVES: Discuss the available pharmaceutical options for weight loss and risks of these medications Explain the

More information

Vascular Risk Reduction: Addressing Vascular Risk

Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction: Addressing Vascular Risk Vascular Risk Reduction (VRR) Welcome! Presentation & Activities Focus: Managing known risk factors for vascular disease. Engage, collaborate and have

More information

Version 1 2015. Module guide. Preliminary document. International Master Program Cardiovascular Science University of Göttingen

Version 1 2015. Module guide. Preliminary document. International Master Program Cardiovascular Science University of Göttingen Version 1 2015 Module guide International Master Program Cardiovascular Science University of Göttingen Part 1 Theoretical modules Synopsis The Master program Cardiovascular Science contains four theoretical

More information

INSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME

INSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME 1 University of Papua New Guinea School of Medicine and Health Sciences Division of Basic Medical Sciences Discipline of Biochemistry and Molecular Biology PBL SEMINAR INSULIN RESISTANCE, POLYCYSTIC OVARIAN

More information

Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost

Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost Naftali Stern Institute of Endocrinology, Metabolism and Hypertension Tel Aviv -Sourasky Medical Center and Sackler

More information

Weight Loss Surgery and Bariatric Nutrition. Jeanine Giordano, MS, RD, CDN

Weight Loss Surgery and Bariatric Nutrition. Jeanine Giordano, MS, RD, CDN Weight Loss urgery and Bariatric Nutrition Jeanine Giordano, M, RD, CDN UA: Mean BMI trends (age standardized) Prevalence of Obesity Among Adults United tates 68% Australia 59% Russia 54% United Kingdom

More information

WHAT DOES DYSMETABOLIC SYNDROME MEAN?

WHAT DOES DYSMETABOLIC SYNDROME MEAN? ! WHAT DOES DYSMETABOLIC SYNDROME MEAN? Dysmetabolic syndrome (also referred to as syndrome X, insulin resistance syndrome, and metabolic syndrome ) is a condition in which a group of risk factors for

More information