National recommendations on arterial hypertension and obesity

Abstract

Obesity is a major risk factor for developing hypertension and weight gain, including overweight and obesity, are important contributors to high BP. On the other hand, hypertension is one of the most common complications of obesity. For obese individuals, the BP target is generally the same as for the general hypertensive population, unless specific comorbidities dictate otherwise The presence of altered carbohydrate metabolism (prediabetes), renal dysfunction (including albuminuria), or cardiovascular disease are determinant¹.

Obesity and hypertension are linked. Compared with nonobese individuals, those who are obese have higher BP levels, even within the normal range. In a study of 3216 adults, 58.1% of those with a normal BP had a normal weight, and only 10.6% were obese, whereas in those with hypertension, 43.7% were obese². The relationship between BMI and BP appears to be almost linear, with the risk of hypertension being 20–30% higher for every 5% elevation in body weight. Clinical studies have also shown that maintaining a BMI less than 25 kg/m2 represents an effective primary prevention for hypertension and that weight loss allows achieving a BP reduction in most hypertensive patients.

Barriers such as low awareness (64% urban) and multimorbidity in LATAM are addressed via primary care strengthening, telemedicine, and the HEARTS initiative (covering 30 million adults). The HEARTS Initiative, led by the WHO and PAHO is a global model for integrating hypertension and DM2 care in primary health, using healthy lifestyles, evidence-based protocols, access to medicines, risk-based management, team care, and monitoring systems (HEARTS), to improve CVD prevention, as shown in countries in LATAM³.

Treatment of hypertension in patients with obesity and/or DM2 should consists in lifestyle changes and pharmacological treatment based on a dual combination of a RAS blocker (ARB or ACEI) with a CCB or a thiazide/thiazide-like diuretic, in a single pill combination. Recommended office BP targets for patients with hypertension and cardiometabolic disturbances are <130/80 mmHg for most (if tolerated). Targets must be individualized in older or frail patients. Treatment of DM2 recommended for patients with hypertension and/or obesity follows international diabetes guidelines.