Hypertension and obesity relationship

Fat people have higher blood pressure. There is, however, an important confounding factor to be taken into account. There is a tendency to overestimate blood pressure in people with fat arms particularly if the blood pressure cuffs are too small. 

The fatter the arm, the greater the overestimation. However, after correction for arm circumstance, there still remains a positive relationship between body mass index (BMI) and both systolic and diastolic blood pressure. There is a suggestion that BMI exerts its effects mainly on diastolic blood pressure with little independent effect on the systolic pressure, which is mainly related to age. 

The mechanism by which obese people have a high blood pressure is uncertain. It is probable that obese people eat more sodium and less potassium and, therefore, may develop a rise in blood pressure due to dietary factors. 

It is probable also that high blood pressure is more closely correlated with central obesity than with BMI alone. Intravenous glucose tolerance tests have demonstrated that obese people are relatively resistant to insulin, and this concept is now the subject of a great deal of research. 

It has been postulated that insulin resistance leads to a rise in intracellular sodium concentration and to renal retention of salt and water. Thus insulin itself may play some role in the aetiology of essential hypertension, particularly in obese individuals. Since obesity is itself associated with high blood lipids levels, glucose intolerance and high blood pressure, fat people are more prone to coronary heart disease. 

It is possible, however, that after allowing for these factor. BMI alone may not itself be an independent cardiovascular risks factor. This is only a theoretical consideration as most obese people do have the other cardiovascular risk factors and thus have a high risk of death. When people lose weight, their blood pressures tend to fall at a rate of 1 mm Hg/kg reduction of body weight. 

Hypertension and obesity relationship

Stage II type of Hypertension

Hypertension is defined as systolic BP above 140 mm Hg or diastolic BP above 90 mm Hg. In Stage II type of Hypertension, the Systolic Pressure is greater than 160 mm Hg or the Diastolic Pressure greater than 100 mm Hg.

For this category of patients, High Blood Pressure Medication, a Diuretic and an ACE Inhibitor is recommended. The two drug formula works faster and keeps blood pressure in control.

In this category, other High Blood Pressure Medications include Beta Blockers, CCBs and Angiotensin II receptor blockers.

Patients with stage 2 hypertension should begin diet and lifestyle changes. Lifestyle changes are a first line weapon in the fight against high blood pressure.

Rather than making a single change, a combination of behavioral changes including losing weight eating heart-hearty foods, reducing sodium, and exercise more, yields the best result.
Stage II type of Hypertension

Stage I type of Hypertension

In Stage I type of Hypertension, there are no other major health problems. Stage 1 hypertension is defined as either a systolic blood pressure of 140 to 159 mm Hg or a diastolic blood pressure of 90 to 99 mm Hg.

Patients with stage 1 hypertension should begin diet and lifestyle changes and should receive one antihypertensive medication, usually a thiazide diuretic.

Consideration is made to give angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta blocker, calcium channel blocker or a combination of these of the individual is still not meeting the goal blood pressure.

All person classified with either stage 1 hypertension or stage 2 hypertension should be treated and have a therapeutic goal of achieving a BP of less than 140/90 mm Hg.
Stage I type of Hypertension

Isolated systolic hypertension

Isolated systolic hypertension mainly a problem of people older than 55 years is defined as systolic blood pressure 140 mm Hg or higher and diastolic blood pressure less than 90 mm Hg.

There are three types of elderly hypertension: isolated systolic hypertension, isolated diastolic hypertension and mixed hypertension.

Among all elderly hypertension cases, 65% are classified as isolated systolic hypertension. After age 55, isolated systolic hypertension is the most common form.  In developed countries, systolic pressure rises steadily with age; by contrast, diastolic pressure rises until about age 55 and then fall progressively thereafter.

 Isolated systolic hypertension occurs in 8% of people in the age stratum 60-69 years and rising to 22% for those aged 80 years or older.

Isolated systolic hypertension is more common in women and is a major risk factor for diastolic heart failure, which also is more common in women.

Secondary causes include disorders associated with either increased cardiac output (anemia, thyrotoxicosis, arteriovenous fistula, Paget disease of bone, and beriberi) or increased cardiac stroke volume.
Isolated systolic hypertension

Definition of Hypertension

Definition of Hypertension
The World Health Organization defined hypertension as: systolic blood pressure > or equal 160mmHg and/or diastolic blood pressure > or equal 95mmHg and border line hypertension as systolic <160 and diastolic pressure 90-94mmHg or systolic 141-159 and diastolic pressure < 90 mmHg. The remainder of the population was considered ‘normotensive’.

Such definitions however are arbitrary because of the continuous nature of the blood pressure distribution. For most cases of hypertension, no underlying clinical case is found on investigation i.e., so called ‘essential’ hypertension. Essential hypertension is type of disease not hitherto recognized in medicine in which the defect is one of degree not of kind, quantitative not qualitative. It is apparently difficult for doctors to understand because it is departure from the ordinary process of binary thought to which they are brought up.

Definitions of hypertension are essentially pragmatic. They may be used to characterize groups of individuals that may benefit from specific treatment regimens – no pharmacologic and pharmacologic. For example, the cut points for ‘hypertension’ may be chosen at the level of blood pressure for which evidence of a treatment benefit is supported by data from randomized controlled clinical trials, and benefits of treatment outweighs risk. However these criteria will exclude the large numbers of people at excess risk from their blood pressure levels, but who are at or below the threshold for therapeutic intervention.
Definition of Hypertension

Blood Pressure and Age Relationship

Blood Pressure and Age Relationship
In most westernized cultures blood pressure rises with age but this trend depends on gender, race and initial level of blood pressure, as well as on an individual’s genetic background and environmental.

Systolic and diastolic blood pressures are approximately 70 to 50 mmHg respectively at birth. Systolic blood pressure on average rises to 94 mmHg at the end of the 1st year, and diastolic blood pressure to 52mmHg. Blood pressure is then unchanged for the next 2-3 years but rises through out childhood and adolescence. Systolic blood pressure (1-2 mmHg) rises more rapidly than diastolic blood pressure so that pulse pressure slowly increases during childhood. Blood pressure in both sexes remains the same until teenage years when girl’s blood pressure rise more slowly than boy’s, so that by 18 years boys have a blood pressure 10mmHg systolic and 5 mmHg diastolic higher than girls.

During adulthood both systolic and diastolic blood pressure rise steadily, although systolic tends to increase more rapidly than diastolic. The age related rise in blood pressure in adults is slightly steeper for women so that by the 7th decade blood pressure in the two sexes is equal: beyond this age it is slightly higher than women. While some of this differential may be explained by selective survival of women with higher blood pressures, the longitudinal study indicates that the same difference is seen in individuals. Similar longitudinal studies indicate that the flattening and slight fall in diastolic blood pressure observed in the elderly is also genuine sequential change.
Blood Pressure and Age Relationship