A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management DOI Creative Commons
Clara García-Carro, Ander Vergara, Sheila Bermejo

et al.

Frontiers in Medicine, Journal Year: 2021, Volume and Issue: 8

Published: April 13, 2021

Obesity is one of the epidemics our era. Its prevalence higher than 30% in U.S. and it estimated to increase by 50% 2030. associated with a risk all-cause mortality known be cause chronic kidney disease (CKD). Typically, obesity-related glomerulopathy (ORG) ascribed renal hemodynamic changes that lead hyperfiltration, albuminuria and, finally, impairment glomerular filtration rate due glomerulosclerosis. Though not only hemodynamics are responsible for ORG: adipokines could local effects on mesangial tubular cells podocytes promoting maladaptive responses hyperfiltration. Furthermore, hypertension type 2 diabetes mellitus, two conditions generally obesity, both amplifiers obesity injury parenchyma, as well complications overweight. As native kidney, also related worse outcomes transplantation. Despite its impact CKD cardiovascular morbility mortality, therapeutic strategies fight against were limited decades renin-angiotensin blockade bariatric surgery patients who accomplished very restrictive criteria. Last years, different drugs have been approved or under study treatment obesity. Glucagon-like peptide-1 receptor agonists promising since they shown benefits terms losing weight obese patients, preventing onset macroalbuminuria slowing decline eGFR diabetes. These new families glucose-lowering frontier crossed nephrologists stop progression.

Language: Английский

Diretrizes Brasileiras de Hipertensão Arterial – 2020 DOI Creative Commons
Weimar Kunz Sebba Barroso, Cibele Isaac Saad Rodrigues, Luiz Aparecido Bortolotto

et al.

Arquivos Brasileiros de Cardiologia, Journal Year: 2021, Volume and Issue: 116(3), P. 516 - 658

Published: March 1, 2021

Content 1. Definition, Epidemiology, and Primary Prevention 528 1.1 Definition of Hypertension […] Brazilian Guidelines – 2020

Language: Английский

Citations

786
Obesity, Hypertension, and Cardiac Dysfunction DOI Open Access
Alan J. Mouton, Xuan Li, Michael E. Hall

et al.

Circulation Research, Journal Year: 2020, Volume and Issue: 126(6), P. 789 - 806

Published: March 12, 2020

Obesity and hypertension, which often coexist, are major risk factors for heart failure characterized by chronic, low-grade inflammation, promotes adverse cardiac remodeling. While macrophages play a key role in remodeling, dysregulation of macrophage polarization between the proinflammatory M1 anti-inflammatory M2 phenotypes excessive inflammation injury. Metabolic shifting glycolysis mitochondrial oxidative phosphorylation has been implicated polarization. primarily rely on glycolysis, whereas tricarboxylic acid cycle phosphorylation; thus, that affect metabolism may disrupt M1/M2 homeostasis exacerbate inflammation. The mechanisms obesity hypertension synergistically induce metabolic dysfunction, particularly during not fully understood. We propose via directly target metabolism, including changes circulating glucose fatty substrates, lipotoxicity, tissue hypoxia. discuss canonical novel roles obesity-hypertension-induced injury, diastolic dysfunction impaired calcium handling. Finally, we current status potential therapies to failure, antidiabetic therapies, immunometabolic agents.

Language: Английский

Citations

388
Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood DOI Open Access
Dorota Drożdż, Julio Álvarez‐Pitti, Małgorzata Wójcik

et al.

Nutrients, Journal Year: 2021, Volume and Issue: 13(11), P. 4176 - 4176

Published: Nov. 22, 2021

Obesity has become a major epidemic in the 21st century. It increases risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic factors components metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction domain adulthood, it is evident that CV continuum begins very early life. Recognition stages damage, at time when these processes still reversible, development prevention strategies pillars reducing morbidity mortality general population. In this review, we will discuss role well-known but also novel linking obesity increased from prenatal age to including perinatal factors, diet, nutrigenomics, nutri-epigenetics, hyperuricemia, cardiorespiratory fitness. The importance ‘tracking’ on adult health highlighted economic impact childhood well preventive discussed.

Language: Английский

Citations

281
Role of Hyperinsulinemia and Insulin Resistance in Hypertension: Metabolic Syndrome Revisited DOI Creative Commons
Alexandre A. da Silva, Jussara M. do Carmo, Xuan Li

et al.

Canadian Journal of Cardiology, Journal Year: 2020, Volume and Issue: 36(5), P. 671 - 682

Published: Feb. 12, 2020

Citations

262
Lifestyle interventions for the prevention and treatment of hypertension DOI
Pedro L. Valenzuela, Pedro Carrera‐Bastos, Beatriz G. Gálvez

et al.

Nature Reviews Cardiology, Journal Year: 2020, Volume and Issue: 18(4), P. 251 - 275

Published: Oct. 9, 2020

Language: Английский

Citations

256
Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease DOI Open Access
Guanghong Jia, James R. Sowers

Hypertension, Journal Year: 2021, Volume and Issue: 78(5), P. 1197 - 1205

Published: Oct. 4, 2021

Epidemiological studies have documented that insulin resistance and diabetes not only constitute metabolic abnormalities but also predispose to hypertension, vascular stiffness, associated cardiovascular disease. Meanwhile, excessive arterial stiffness impaired vasorelaxation, in turn, contribute worsening the development of diabetes. Molecular mechanisms promoting hypertension include inappropriate activation renin-angiotensin-aldosterone system sympathetic nervous system, mitochondria dysfunction, oxidative stress, systemic inflammation. This review highlights recent which uncovered new underlying for increased propensity association with These enhanced epithelial sodium channels, alterations extracellular vesicles their microRNAs, abnormal gut microbiota, renal sodium-glucose cotransporter activity, collectively covers socioeconomic factors currently recommended blood pressure targets related treatment strategies diabetic patients hypertension.

Language: Английский

Citations

226
Obesity and the risk of cardiometabolic diseases DOI
Pedro L. Valenzuela, Pedro Carrera‐Bastos, Adrián Castillo‐García

et al.

Nature Reviews Cardiology, Journal Year: 2023, Volume and Issue: 20(7), P. 475 - 494

Published: March 16, 2023

Language: Английский

Citations

217
Obesity and heart failure with preserved ejection fraction: new insights and pathophysiological targets DOI
Barry A. Borlaug, Michael D. Jensen, Dalane W. Kitzman

et al.

Cardiovascular Research, Journal Year: 2022, Volume and Issue: 118(18), P. 3434 - 3450

Published: July 26, 2022

Abstract Obesity and heart failure with preserved ejection fraction (HFpEF) represent two intermingling epidemics driving perhaps the greatest unmet health problem in cardiovascular medicine 21st century. Many patients HFpEF are either overweight or obese, recent data have shown that increased body fat its attendant metabolic sequelae widespread, protean effects systemically on system leading to symptomatic HFpEF. The paucity of effective therapies underscores importance understanding distinct pathophysiological mechanisms obese develop novel therapies. In this review, we summarize current non-cardiovascular features phenotype HFpEF, how adiposity might pathophysiologically contribute phenotype, these processes be targeted therapeutically.

Language: Английский

Citations

191
Obesity, kidney dysfunction, and inflammation: interactions in hypertension DOI Open Access
John E. Hall, Alan J. Mouton, Alexandre A. da Silva

et al.

Cardiovascular Research, Journal Year: 2020, Volume and Issue: 117(8), P. 1859 - 1876

Published: Nov. 17, 2020

Abstract Obesity contributes 65–75% of the risk for human primary (essential) hypertension (HT) which is a major driver cardiovascular and kidney diseases. Kidney dysfunction, associated with increased renal sodium reabsorption compensatory glomerular hyperfiltration, plays key role in initiating obesity-HT target organ injury. Mediators dysfunction blood pressure include (i) elevated sympathetic nerve activity (RSNA); (ii) antinatriuretic hormones such as angiotensin II aldosterone; (iii) relative deficiency natriuretic hormones; (iv) compression by fat around kidneys; (v) activation innate adaptive immune cells that invade tissues throughout body, producing inflammatory cytokines/chemokines contribute to vascular injury, exacerbate HT. These neurohormonal, renal, mechanisms are interdependent. For example, excess adiposity increases adipocyte-derived cytokine leptin RSNA stimulating central nervous system proopiomelanocortin-melanocortin 4 receptor pathway. Excess visceral, perirenal sinus compress kidneys which, along RSNA, renin–angiotensin–aldosterone activation, although obesity may also activate mineralocorticoid receptors independent aldosterone. Prolonged obesity, HT, metabolic abnormalities, inflammation cause progressive making HT more resistant therapy often requiring multiple antihypertensive drugs concurrent treatment dyslipidaemia, insulin resistance, diabetes, inflammation. More effective anti-obesity needed prevent cascade cardiorenal, metabolic, disorders threaten overwhelm health care systems prevalence continues increase.

Language: Английский

Citations

151
Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association DOI Open Access
Michael E. Hall, Jordana B. Cohen, Jamy D. Ard

et al.

Hypertension, Journal Year: 2021, Volume and Issue: 78(5)

Published: Sept. 20, 2021

Hypertension is a major risk factor for cardiovascular and renal diseases in the United States worldwide. Obesity accounts much of primary hypertension through several mechanisms, including neurohormonal activation, inflammation, kidney dysfunction. As prevalence obesity continues to increase, associated cardiorenal will also increase unless more effective strategies prevent treat are developed. Lifestyle modification, diet, reduced sedentariness, increased physical activity, usually recommended patients with obesity; however, long-term success these reducing adiposity, maintaining weight loss, blood pressure has been limited. Effective pharmacotherapeutic procedural strategies, metabolic surgeries, additional options or attenuate hypertension, target organ damage, subsequent disease. Medications can be useful short- treatment; prescription drugs Metabolic surgery producing sustained loss treating disorders many severe obesity. Unanswered questions remain related mechanisms obesity-related diseases, efficacy different treatment prevention timing interventions hypertension-mediated damage. Further investigation, randomized controlled trials, essential addressing questions, emphasis should placed on reduce burden hypertensive mortality.

Language: Английский

Citations

149