Obesity, metabolic syndrome, and primary hypertension

• Published in: Pediatric nephrology (Berlin, West) Vol. 36; no. 4; pp. 825 - 837
• Main Authors: Litwin, Mieczysław, Kułaga, Zbigniew
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2021; Springer; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Blood pressure; Body composition; Body Mass Index; Complications and side effects; Development and progression; Educational Review; Essential Hypertension; Humans; Hypertension; Hypertension - epidemiology; Hypertension - etiology; Medicine; Medicine & Public Health; Metabolic syndrome; Metabolic Syndrome - complications; Metabolic Syndrome - epidemiology; Metabolic syndrome X; Nephrology; Obesity; Obesity - complications; Obesity - epidemiology; Obesity in adolescence; Obesity in children; Obesity, Metabolically Benign; Pediatric research; Pediatrics; Phenotype; Phenotypes; Risk Factors; Teenagers; Urology; What’s new in Hypertension; Poland; Adolescence; Obesity-related hypertension; Primary hypertension; Metabolic syndrome; Metabolically healthy obesity; Metabolically unhealthy obesity
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-020-04579-3

Primary hypertension is the dominant form of arterial hypertension in adolescents. Disturbed body composition with, among other things, increased visceral fat deposition, accelerated biological maturation, metabolic abnormalities typical for metabolic syndrome, and increased adrenergic drive constitutes the intermediary phenotype of primary hypertension. Metabolic syndrome is observed in 15–20% of adolescents with primary hypertension. These features are also typical of obesity-related hypertension. Metabolic abnormalities and metabolic syndrome are closely associated with both the severity of hypertension and the risk of target organ damage. However, even though increased body mass index is the main determinant of blood pressure in the general population, not every hypertensive adolescent is obese and not every obese patient suffers from hypertension or metabolic abnormalities typical for metabolic syndrome. Thus, the concepts of metabolically healthy obesity, normal weight metabolically unhealthy, and metabolically unhealthy obese phenotypes have been developed. The risk of hypertension and hypertensive target organ damage increases with exposure to metabolic risk factors which are determined by disturbed body composition and visceral obesity. Due to the fact that both primary hypertension and obesity-related hypertension present similar pathogenesis, the principles of treatment are the same and are focused not only on lowering blood pressure, but also on normalizing body composition and metabolic abnormalities.