Transcript ΥΠΕΡΤΑΣΗ ΚΑΙ ΠΑΧΥΣΑΡΚΙΑ

ΠΑΧΥΣΑΡΚΙΑ ΥΠΕΡΤΑΣΗ
ΚΑΙ ΚΑΡΔΙΑΓΓΕΙΑΚΟΣ
ΚΙΝΔΥΝΟΣ
ΑΝΔΡΕΑΣ ΠΙΤΤΑΡΑΣ MD
Hypertension at age 15
Type 2 DM at age 23
Renal failure at age 32
First MI at age 35 (survives)
CHF at age 37
Second MI at age 40
Excess bodyweight is increasingly
prevalent in children and adolescents
Prevalence (%)
30
More than 80 million European children
and adolescents are now overweight or
25
obese
UK
Spain
20
Poland
France
15
Czech Republic
10
Netherlands
Switzerland
5
0
1960
65
70
75
80
Year
85
90
95
2000 2005
IOTF/EASO Obesity in Europe Report 2002; IOTF 2004
Overweight (%)
Equivalent to BMI>25
10
7-11 years
9
14-17 years
18
15
17
27
25
18
12
11
16
13
12
18
17
9
8
12
19
22
33
34
21
26
20
36
17
17
18
17
31
22
© IOTF 2004.
IOTF-Cole et al
definition of
overweight
34
35
33
27
23
WORLD Attributable Mortality in 2000 by Selected Leading
Risk Factors
High Blood Pressure
High BMI
›
Number of Deaths (in thousands)
Obesity is associated with an increased
prevalence of hypertension
40
men
women
% of population
30
20
10
0
<25
NTFPTO, Arch Intern Med 2000; 160: 898-904
25-26
BMI
27-29
30
Proportion of hypertensive patients in different BMI
categories in Finland in 1997 (population-based survey)
FEMALES
MALES
12%
15%
47%
49%
41%
36%
Normal-weight
Kastarinen et al., J Hypertens 2000;18:255-262
Overweight
Obese
Obesity, Hypertension and LV Geometry
Prevalence of LVH
Normal
70
Obese
Hypertensive
MEN
50
%
30
10
Kuch et al., J Hum Hypertens 1998;12:685-91
Obese plus Hypertensive
WOMEN
Obesity and Heart
Systolic and diastolic function
 50 obese subjects
twice ideal body
weight
echocardiography
 Exclusion criteria:
hypertension,
organic heart
disease,
congestive heart
failure.
Alpert, M.A. et al. Int. J. Obes. 1995; 19: 550-557.
Congestive Heart Failure (CHF) and Obesity
Framingham Study: 5881 M & W, mean age 55 yrs, 14 years follow-up
Kenchman S, Evans J, Levy D et al. Obesity and the risk of heart failure. NEJM 2002;347:305-313
Obesity increases Risk for Diabetes
Most BMI >35 vs < 22 kg/m2
Males
50
Females
77,690 females and 46,060 males adjusted for age,
smoking, race, 10-year risk
41.2
30.1
Odds Ratio
30
5
3.3
4
3
2
3.7
4.2
2.9
BMI
<22.0
2.4
1.7
1
0
Gallstones
Field et al, Archives Internal Medicine 2001
 BP
Coronary Disease Diabetes
Prevalence Map of RCA Lesions in Young Men
- 3002 subjects studied at autopsy, aged 15 -34
McGill HC et al. Circulation 2002;105:2712-2718
High BMI increases
Risk of Cardiovascular Mortality
Relative risk of CV death
Women (n=98539)
Men (n=25736)
4
Aged 45-54, never-smokers
3
2
1
0
<19
19-21.9
22-24.9
25-26.9
BMI
Stevens J, N Engl J Med 1998;338(1):1-7
27-28.9
29-31.9
32
Life expectancy at age 40:
Impact of excess body weight
Framingham Heart Study
Overweight 25–29.9 kg/m 2
50
Life expectancy (years)
Normal 18.5–24.9 kg/m 2
Obese 30 kg/m 2
3.3 y
45
7.1 y
46.3
3.1 y
5.8 y
43.4
43.0
40
40.3
39.2
37.5
35
Female non-smoker
Peeterset al. Ann Intern Med, 2003
Male non-smoker
Mechanisms linking obesity to hypertension
Activation of
sympathetic nervous
system
Inflammation
Oxidative stress
Sodium and volume
retention
Visceral
Obesity
Endothelial
dysfunction
Renal
dysfunction
Insulin and leptin
resistance
Activation of reninangiotensin system
CONTROL
OSA
OBSTRUCTIVE SLEEP APNEA
MSNA
Respirogram
OSA
OSA
OSA
OSA
OSA
250
BP
125
0
10 s
Somers V.K., Dyken M.E., Clary M.P., Abboud F.M. J. Clin. Invest. 1995, 96: 1897-1904
Percentage
Cumulative incidence of fatal CV events
Follow-up (months)
Marin JM et al. Lancet 2005
Extraordinarily high prevalence of unrecognized
sleep apnea in drug-resistant hypertension
(3 or more antihypertensive drugs, titrated to maximal dose)
FEMALES
65%
Logan et al, J Hypertens 2001; 19: 2271-7.
MALES
97%
Factors influencing prognosis
ESH/ESC guidelines 2003
Risk factors for cardiovascular disease
used for stratification
 Levels of systolic and diastolic BP
 Men > 55 years
 Women > 65 years
 Smoking
 Dyslipidaemia
(total cholesterol >6.5 mmol/l, >250 mg/dl *,
or LDL-cholesterol > 4.0 mmol/l, >155 mg/dl*,
or HDL-cholesterol M < 1.0, W< 1.2 mmol/l, M< 40,W < 48 mg/dl)
 Family history of premature cardiovascular disease
(at age < 55 years M, < 65 years W)
Abdominal obesity
(abdominal circumference M  102 cm, W  88 cm)
 C-reactive protein  1 mg/dl
M, men; W, women; LDL, low-density lipoprotein; HDL, high-density lipoprotein; LVMI, left ventricular mass index; IMT, intima-media thickness. Lower levels
of total and LDL-cholesterol are known to delineate increased risk, but they were not used in the stratification
Hypertension as a predictor of obesity
NBP - normotensives
B-HBP - borderlline hypertensives
B-HBP - hypertensives
Kannel et al., Ann Intern Med. 1967;67:48–59; Julius et al., Hypertension 2000;5:807-813
Obesity and Hypertension: a 2-way Street ?
Obese subjects are prone to hypertension
Hypertensives are prone to weight gain
OBESITY
HYPERTENSION
Julius, Palatini Hypertension 2000;5:807-813
Conclusions
1.
Obesity is the most important risk factor
for the development of hypertension
2. Adipose tissue may be directly involved
in the pathogenesis of hypertension and
increased cardiovascular risk
3. Sleep apnea may contribute to elevated
levels of blood pressure in a large
proportion of obese hypertensives