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New developments in the pathogenesis of obesity-induced hypertension

Kotsis, Vasiliosa; Nilsson, Peterb; Grassi, Guidoc; Mancia, Giusepped; Redon, Josepe; Luft, Frankf; Schmieder, Rolandg; Engeli, Stefanh; Stabouli, Stellai; Antza, Christinaa; Pall, Denesj; Schlaich, Markusk; Jordan, Jensjon behalf of the WG on Obesity, Diabetes, the High Risk Patient, European Society of Hypertension

doi: 10.1097/HJH.0000000000000645

Obesity is a disorder that develops from the interaction between genotype and environment involving social, behavioral, cultural, and physiological factors. Obesity increases the risk for type 2 diabetes mellitus, hypertension, cardiovascular disease, cancer, musculoskeletal disorders, chronic kidney and pulmonary disease. Although obesity is clearly associated with an increased prevalence of hypertension, many obese individuals may not develop hypertension. Protecting factors may exist and it is important to understand why obesity is not always related to hypertension. The aim of this review is to highlight the knowledge gap for the association between obesity, hypertension, and potential genetic and racial differences or environmental factors that may protect obese patients against the development of hypertension and other co-morbidities. Specific mutations in the leptin and the melaninocortin receptor genes in animal models of obesity without hypertension, the actions of α-melanocyte stimulating hormone, and SNS activity in obesity-related hypertension may promote recognition of protective and promoting factors for hypertension in obesity. Furthermore, gene–environment interactions may have the potential to modify gene expression and epigenetic mechanisms could also contribute to the heritability of obesity-induced hypertension. Finally, differences in nutrition, gut microbiota, exposure to sun light and exercise may play an important role in the presence or absence of hypertension in obesity.

aHypertension-24 h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University Thessaloniki, Greece

bDepartment of Clinical Sciences, Lund University, University Hospital, Malmö, Sweden

cDepartment of Health Science, University of Milano-Bicocca, Milano, Italy and Istituto di Ricerche a Carattere Scientifico Multimedica IRCCS, Sesto San Giovanni, Milan

dIstituto Auxologico Italiano, Milano, Italy

eUniversity of Valencia and INCLIVA Research Institute and CIBERobn, Madrid, Spain

fExperimental and Clinical Research Center, Kooperation zwischen dem Max-Delbrück-Centrum für Molekulare Medizin und der Medizinischen Fakultät der Charité, Berlin

gAbteilung für Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen

hInstitute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany

i1st Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Greece

jDepartment of Medicine, Debrecen University, Hungary

kSchool of Medicine and Pharmacology Royal Perth Hospital Unit, University of Western Australia, Baker IDI Heart and Diabetes Institute, Melbourne, Australia

Correspondence to Vasilios Kotsis, Hypertension-24 h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University Thessaloniki, Thessaloniki 54124, Greece. Tel: +30 6974748860; fax: +30 2310991496; e-mail:

Received 30 March, 2015

Revised 30 April, 2015

Accepted 30 April, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.