One in eight people are said to suffer from high blood pressure in India, as per the National Health Survey, 2017. This translates to approximately 207 million Indians. High blood pressure is now one of the leading causes of premature deaths and is directly responsible for about 50% strokes and 25% coronary heart disease deaths in India.
With rising rates of obesity all over the world, there is a corresponding increase in obesity-related diseases such as type 2 diabetes, high blood pressure and heart disease. Together these form the metabolic syndrome.
People with obesity are 3.5 times more likely to develop high blood pressure. It has been estimated that almost 60 to 70% cases of hypertension in adults can be directly attributed to obesity. Children with obesity are also three times more likely to develop high blood pressure.
Factors like unhealthy diet, lack of physical activity, and high stress levels play an important role in developing obesity-related hypertension. Not to mention, certain physiological ailments and genetic elements have a role to play too!
People with higher levels of visceral or abdominal obesity as well as those with insulin resistance tend to develop high blood pressure. Hormones like leptin and adiponectin have been implicated.
Obesity is also a risk factor for developing obstructive sleep apnea and that is another cause for high blood pressure in many individuals. Fat surrounding the kidneys and increased intra-abdominal pressure leads to an increase in the kidney pressure. There is an increase in sodium retention in individuals with obesity and this adds to the obesity related hypertension.
Activation of the renin-angiotensin system also adds to hypertension in obesity. Impaired (endothelium) lining of the vessel walls has been seen with all the above-mentioned mechanisms and contributes to high blood pressure.
The treatment of obesity-related hypertension is similar to the treatment of hypertension. Most patients are put on blood pressure medications by their physicians. However, weight reduction is of utmost importance and can be a game changer.
In addition to medications, lifestyle modification is of great importance. Healthy diet, regular exercise, less stress and good sleep hygiene are pillars of management for all chronic lifestyle diseases including hypertension. Weight management is a must in patients who have obesity related hypertension.
Well, overweight (BMI 23.5 to 27.5 Kg/m2) individuals must consult a qualified weight loss specialist and must get on a medically supervised weight loss program. The earlier this is done, the better the results.
Individuals with grade 1 obesity (BMI 27.5 to 32.5 Kg/m2) must remain committed to the weight loss program under supervision. If the weight is not coming down despite multiple sustained efforts, medical therapy or endoscopic weight loss therapies like intra-gastric balloon insertion may be attempted under the guidance of weight loss specialists.
For patients with grade 2 or 3 obesity, weight loss must be the primary objective. As the weight continues to increase these individuals tend to develop other components of the metabolic syndrome like diabetes and cholesterol-related issues in addition to high blood pressure. Together these conditions significantly increase the risk of developing heart disease. In such cases bariatric/metabolic surgery may be an effective option for weight loss as well as for improvement of hypertension and other obesity related diseases.
High blood pressure caused by obesity must be viewed in a holistic manner and treatment must include weight management along with pharmacological management of high blood pressure. Well-controlled blood pressure is of the utmost importance to reduce the risk of heart disease.