Circulation, Vol 87, 1482-1488, Copyright © 1993 by American Heart Association
RE Schmieder and FH Messerli
BACKGROUND. Various prospective studies have found that lean hypertensive
patients have greater cardiovascular morbidity and mortality than obese
hypertensive subjects. It was therefore hypothesized that hypertension is
more benign when associated with obesity. In the present study, we
evaluated effects of obesity on early target organ damage in patients with
essential hypertension. METHODS AND RESULTS. In a total of 207 subjects,
systemic and renal hemodynamics as well as left ventricular structure and
function were assessed by measuring cardiac output (indocyanine green dye
dilution), renal blood flow (clearance of 131I paraimmunohippuric acid),
and mean arterial pressure (invasively) and by two-dimensionally guided
M-mode echocardiographic findings. Systemic and renal vascular resistance,
compliance of the large arteries evaluated by the stroke volume/pulse
pressure index, and left ventricular mass served as parameters for early
target organ damage. All individuals were categorized into four groups:
lean and obese normotensive as well as lean and obese hypertensive
subjects. In obese hypertensive patients, total peripheral resistance was
significantly lower and stroke volume/pulse pressure index was higher than
in the lean hypertensive group, almost reaching values of normotensive
control subjects. No effect of obesity on the renal circulation was noted,
whereas in hypertension, renal vascular resistance was elevated. The degree
of left ventricular hypertrophy was more pronounced in the hypertensive
groups than in their normotensive counterparts and progressively increased
with obesity. Nevertheless, in obese hypertensive patients, left
ventricular function, as measured by fractional fiber shortening and
velocity of circumferential fiber shortening, was maintained despite the
fact that the heart had been exposed to the double burden of an increased
preload (obesity) and afterload (hypertension). CONCLUSIONS. Obesity had a
disparate effect on target organs in hypertension. At rest, obesity seemed
to mitigate cardiovascular changes in the systemic vascular bed caused by
hypertension. However, no such mitigation was observed in the renal
vasculature, and left ventricular hypertrophy was even exacerbated by the
presence of obesity. Our findings in part negate the concept that obesity
is able to exert a protective effect on early target organ damage in
hypertensive patients and, in particular, on the heart.
ARTICLES
Does obesity influence early target organ damage in hypertensive patients?
Department of Medicine, University of Erlangen-Nurnberg, Germany.
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