Obesity: Redon J

Redon J, Cifkova R, Laurent S, Nilsson P, Narkiewicz K, Erdine S, Mancia G, Anonymous00057. · University of Valencia and CIBER 06/03 Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain. · J Hypertens. · Pubmed #18806611 No free full text.

Abstract: The metabolic syndrome considerably increases the risk of cardiovascular and renal events in hypertension. It has been associated with a wide range of classical and new cardiovascular risk factors as well as with early signs of subclinical cardiovascular and renal damage. Obesity and insulin resistance, beside a constellation of independent factors, which include molecules of hepatic, vascular, and immunologic origin with proinflammatory properties, have been implicated in the pathogenesis. The close relationships among the different components of the syndrome and their associated disturbances make it difficult to understand what the underlying causes and consequences are. At each of these key points, insulin resistance and obesity/proinflammatory molecules, interaction of demographics, lifestyle, genetic factors, and environmental fetal programming results in the final phenotype. High prevalence of end-organ damage and poor prognosis has been demonstrated in a large number of cross-sectional and a few number of prospective studies. The objective of treatment is both to reduce the high risk of a cardiovascular or a renal event and to prevent the much greater chance that metabolic syndrome patients have to develop type 2 diabetes or hypertension. Treatment consists in the opposition to the underlying mechanisms of the metabolic syndrome, adopting lifestyle interventions that effectively reduce visceral obesity with or without the use of drugs that oppose the development of insulin resistance or body weight gain. Treatment of the individual components of the syndrome is also necessary. Concerning blood pressure control, it should be based on lifestyle changes, diet, and physical exercise, which allows for weight reduction and improves muscular blood flow. When antihypertensive drugs are necessary, angiotensin-converting enzyme inhibitors, angiotensin II-AT1 receptor blockers, or even calcium channel blockers are preferable over diuretics and classical beta-blockers in monotherapy, if no compelling indications are present for its use. If a combination of drugs is required, low-dose diuretics can be used. A combination of thiazide diuretics and beta-blockers should be avoided.

Redon J, Lurbe E. · No affiliation provided · Med Clin (Barc). · Pubmed #18005632 No free full text.

This publication has no abstract.

Redon J, Cífková R, Narkiewicz K. · Hypertension Clinic, Internal Medicine, Hospital Clinico, University of Valencia, Valencia, Spain. · Pol Arch Med Wewn. · Pubmed #19413186 links to  free full text

Abstract: Arterial hypertension is often part of a larger constellation of anthropometric and metabolic abnormalities that includes abdominal (or visceral) obesity, characteristic dyslipidemia (low high-density lipoprotein cholesterol and high triglycerides), glucose intolerance, insulin resistance and hyperuricemia. Using Adult Treatment Panel III criteria, prevalence is higher than in the general population and the metabolic syndrome (MS) can be found in as many as one third of patients. In hypertensives with MS, a high prevalence of hypertension-induced target organ damage and a negative prognostic value have been described. Dietary advice and life style changes should be strongly recommended and prompt pharmacologic treatment is required to control high blood pressure and to reduce risk. The effect of particular antihypertensive drugs on other components of the MS is an important clinical issue with consequences for the success of the treatment.

Redon J, Cifkova R, Laurent S, Nilsson P, Narkiewicz K, Erdine S, Mancia G. · University of Valencia, CIBER 06/03 Fisiopatología de la Obesidad y Nutrición, Institute of Health Carlos III, Madrid, Spain. · J Hypertens. · Pubmed #19262221 No free full text.

Abstract: Arterial hypertension is often part of a constellation of anthropometric and metabolic abnormalities that occur simultaneously to a higher degree than would be expected by chance alone, supporting the existence of a discrete disorder, the so-called metabolic syndrome. It is the result of interactions among a large number of interconnected mechanisms, which eventually lead to both an increase in cardiovascular and renal risk, and the development of diabetes. Mechanisms involved in the metabolic syndrome are obesity, insulin resistance, and a constellation of independent factors, which include molecules of hepatic, vascular, and immunologic origin with pro-inflammatory properties. At each of these key points are interactions of demographics, lifestyle, genetic factors, and environmental fetal programming. Superimposing upon these are infections or chronic exposure or both to certain drugs that can also make their contribution. Skeletal muscle and the liver, not adipose tissue, are the two key insulin-response tissues involved in maintaining glucose balance, although abnormal insulin action in the adipocytes also plays a role in development of the syndrome. Factors commonly associated with and partly dependent on obesity, insulin resistance, such as overactivity of the sympathetic, stimulation of the renin-angiotensin-aldosterone systems, abnormal renal sodium handling, endothelial dysfunction, and large vessels' alterations, may play a key role in the blood pressure elevation of the syndrome.

Redon J, Cífková R. · Hypertension Clinic, Internal Medicine, Hospital Clinico, University of Valencia, 46010 Valencia, Spain. · Curr Hypertens Rep. · Pubmed #17686382 No free full text.

Abstract: Arterial hypertension is often part of a larger constellation of anthropometric and metabolic abnormalities that includes abdominal (or visceral) obesity, characteristic dyslipidemia (low high-density lipoprotein cholesterol and high triglyceride levels), glucose intolerance, insulin resistance, and hyperuricemia. Using National Cholesterol Education Program Adult Treatment Panel III criteria, prevalence is higher than in the general population and the metabolic syndrome can be found in as many as one third of patients. Among hypertensives with metabolic syndrome, a high prevalence of hypertension-induced target-organ damage and a poor prognostic value has been described. Dietary advice and lifestyle changes should be strongly recommended and prompt pharmacologic treatment is required to control high blood pressure and to reduce risk. The impact of particular antihypertensive drugs on other components of the metabolic syndrome is an important clinical issue with consequences for the success of treatment.

Jordan J, Engeli S, Redon J, Sharma AM, Luft FC, Narkiewicz K, Grassi G, Anonymous00199. · Franz Volhard Clinical Research Center and Department of Nephrology, HELIOS Klinikum Berlin and Medical Faculty of the Charité, Berlin, Germany. · J Hypertens. · Pubmed #17351387 No free full text.

This publication has no abstract.

Redon J, Pascual JM. · Hypertension Clinic, Internal Medicine, Hospìtal Clinico, Avda Blasco Ibañez, 17, 46010 Valencia, Spain. · Curr Hypertens Rep. · Pubmed #16672152 No free full text.

Abstract: During the past few years, microalbuminuria has become a prognostic marker for cardiovascular and/or renal risk in diabetic and nondiabetic subjects. In essential hypertensives, an increased transglomerular passage of albumin may result from several mechanisms--hyperfiltration, glomerular basal membrane abnormalities, endothelial dysfunction, and nephrosclerosis. Cross-sectional studies have demonstrated that the main factors related to microalbuminuria are blood pressure (BP) values and hyperinsulinemia, as an expression of insulin resistance. Genetics, obesity, and smoking, however, have also been implicated as determinants of microalbuminuria in some of the studies. Follow-up studies support the role of BP values and subtle alterations in glucose metabolism, although contributing roles need to be assessed in further studies. It seems that the significance of microalbuminuria in essential hypertension is much broader than expected, and several factors may influence the presence of microalbuminuria. Thus, to reverse microalbuminuria, and to reduce urine albumin excretion and cardiovascular and renal risk, a strategy of multiple approaches may be needed. Whether or not the multiple approaches need to be implemented from the beginning or step by step in an individual approach should be established in the near future.

Redon J. · Hypertension Clinic, Hospital Clinico, University of Valencia, Avda Blasco Ibañez 17, 46010 Valencia, Spain. · Nutr Metab Cardiovasc Dis. · Pubmed #11887431 No free full text.

Abstract: AIM: To review various topics regarding the relationship between obesity and hypertension. DATA SUMMARY: Obesity is a widespread and increasingly prevalent condition associated with a large number of comorbid diseases, one of the most important of which is obesity-induced hypertension (HTN). The association between obesity and HTN has been well documented in most racial, ethnic and socio-economic groups, although the relationship between body mass index (BMI) and blood pressure values depends on age, gender, type of obesity and race differences. Obesity-induced HTN has some unique characteristics that differ from those observed in lean hypertensive patients. The hemodynamic profile of obese subjects is characterised by high cardiac output, high plasma and total blood volume, and inappropriately normal to total peripheral resistance. Clinically, hypertensive obese subjects are more likely to develop left ventricular hypertrophy and kidney damage than their lean counterparts. Various common factors are involved in establishing sodium retention and vascular resistance and may be critically influenced by the neurobiological/genetic mechanisms leading to obesity, in which insulin, leptin and the adrenergic system play major roles. Obesity is one of the main causes of therapeutic failure, and a number of studies have demonstrated that obese subjects need more antihypertensive drugs than sex and age-matched lean hypertensives. Long-term dietary treatment, consisting of a moderate restriction of energy and salt intake, is the most effective and safe treatment for obesity-associated HTN. The use of treatments other than calorie restriction should be considered with caution. Drugs that increase energy expenditure or reduce appetite may variably increase blood pressure (BP) and are unsuitable for hypertensive subjects. There do not seem to be any clear differences in the efficacy of the various antihypertensive drug classes. The clustering of cardiovascular risk factors other than HTN needs to be taken into account when choosing antihypertensive treatment for obese subjects. CONCLUSIONS: Obesity is a highly prevalent condition that causes or exacerbates many health problems including HTN. Combined interventions at different levels can help in losing weight and therefore reduce the cardiovascular risk, morbidity and mortality associated with obesity.

Lurbe E, Alvarez V, Redon J. · Pediatric Nephrology Unit, Department of Pediatrics, Hospital General, University of Valencia, Valencia, Spain. · J Clin Hypertens (Greenwich). · Pubmed #11723358 No free full text.

Abstract: Obesity is a common disease with an ever-increasing prevalence and usually with late-onset consequences. If acquired during childhood, it tracks into adult life to some extent, and since the relationship between obesity and hypertension is well established in adults, obese children appear to be at particularly high risk of becoming hypertensive adults. In the authors' study, obese children seemed to have significantly higher casual and ambulatory blood pressure than nonobese children, except for nighttime diastolic blood pressure. The health effects of obesity may depend on the anatomic distribution of body fat, which in turn may be a better indicator of endocrinologic imbalance, environmental stress, or genetic factors than is fatness per se. Subjects with a higher waist-to-hip ratio or a larger waist, as an estimate of central obesity, tend to have higher blood pressure values even during childhood. Prevention of the onset of obesity in early life may be important to reducing the risk of coronary heart disease in later life.

Lurbe E, Carvajal E, Torro I, Aguilar F, Alvarez J, Redon J. · Department of Pediatrics, Consorcio Hospital General, University of Valencia, Valencia, Spain. · Hypertension. · Pubmed #19414646 No free full text.

Abstract: The aim of this study was to assess the impact of obesity and low birth weight on both office and ambulatory blood pressure (BP) values, as well as on aortic-derived parameters in youths. A total of 422 white youths, from 10 to 18 years of age, were included. Subjects were divided into 4 groups according to the presence (234; 55%) or the absence (188; 45%) of obesity and according to low (114; 27%) or normal (308; 73%, birth weight. Spacelabs 90207 was used to measure ambulatory BP during a 24-hour period. SphygmoCor radial/aortic transform software was used to estimate aortic pressure waveform. Office, 24-hour, daytime, and nighttime systolic BP values were significantly higher in those subjects with low birth weight who became obese. The lowest BP values were present in nonobese subjects in the absence of low birth weight. In the middle, with similar BP values, were nonobese subjects with low birth weight and obese subjects in the absence of low birth weight. No interaction existed between obesity and low birth weight in the office (P=0.165) or ambulatory (P=0.603) systolic BP values. Augmentation index, an estimate of the pulse wave reflection, was significantly higher in the nonobese low birth weight group when compared with the other groups after controlling for height, heart rate, and diastolic BP. A significant interaction between low birth weight and obesity (P<0.005) existed. In conclusion, although the low birth weight children who become obese have the highest systolic BP values, the presence of obesity blunts the increment of the reflecting wave observed in low birth weight subjects.

de la Sierra A, Redon J, Banegas JR, Segura J, Parati G, Gorostidi M, de la Cruz JJ, Sobrino J, Llisterri JL, Alonso J, Vinyoles E, Pallarés V, Sarría A, Aranda P, Ruilope LM, Anonymous00106. · Hypertension Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Villarroel 170, E-08036 Barcelona, Spain. · Hypertension. · Pubmed #19171788 No free full text.

Abstract: Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In addition to 24-hour values, the circadian variation of BP adds prognostic significance in predicting cardiovascular outcome. However, the magnitude of circadian BP patterns in large studies has hardly been noticed. Our aims were to determine the prevalence of circadian BP patterns and to assess clinical conditions associated with the nondipping status in groups of both treated and untreated hypertensive subjects, studied separately. Clinical data and 24-hour ambulatory BP monitoring were obtained from 42,947 hypertensive patients included in the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry. They were 8384 previously untreated and 34,563 treated hypertensives. Twenty-four-hour ambulatory BP monitoring was performed with an oscillometric device (SpaceLabs 90207). A nondipping pattern was defined when nocturnal systolic BP dip was <10% of daytime systolic BP. The prevalence of nondipping was 41% in the untreated group and 53% in treated patients. In both groups, advanced age, obesity, diabetes mellitus, and overt cardiovascular or renal disease were associated with a blunted nocturnal BP decline (P<0.001). In treated patients, nondipping was associated with the use of a higher number of antihypertensive drugs but not with the time of the day at which antihypertensive drugs were administered. In conclusion, a blunted nocturnal BP dip (the nondipping pattern) is common in hypertensive patients. A clinical pattern of high cardiovascular risk is associated with nondipping, suggesting that the blunted nocturnal BP dip may be merely a marker of high cardiovascular risk.

Schlaich MP, Grassi G, Lambert GW, Straznicky N, Esler MD, Dixon J, Lambert EA, Redon J, Narkiewicz K, Jordan J, Anonymous00069, Anonymous00070. · Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia. · J Hypertens. · Pubmed #19155773 No free full text.

This publication has no abstract.

Lurbe E, Torro I, Aguilar F, Alvarez J, Alcon J, Pascual JM, Redon J. · Pediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain. · Hypertension. · Pubmed #18195166 links to  free full text

Abstract: The aim of the present study was to analyze the relationship between insulin resistance and the ambulatory blood pressure components in obese children and adolescents. Eighty-seven overweight and obese white children and adolescents of both sexes, of European origin from 6 to 18 years of age (mean age: 10.9+/-2.7 years), were selected. Obesity was defined on the basis of a threshold body mass index z score >2 (Cole's least mean square method) and overweight with a body mass index from the 85th to 97th percentile. A validated oscillometric method was used to measure ambulatory BP (Spacelabs 90207) during 24 hours. Fasting glucose and insulin were measured, and the homeostasis model assessment index was calculated. Subjects were grouped into tertiles of homeostasis model assessment index. No significant differences in terms of age, sex, and body mass index z score distribution were observed among groups. When adjusted by age, sex, and height, nocturnal systolic blood pressure and heart rate were significantly higher in subjects in the highest homeostasis model assessment index tertile (>4.7) as compared with those of the other groups, whereas no differences were observed for awake systolic blood pressure or heart rate. Whereas body mass index z score was more closely related with blood pressure and heart rate values, waist circumference was strongly related with insulin resistance. Moreover, both waist circumference and insulin resistance were mainly associated with higher nocturnal but not with awake blood pressure. The early increment of nocturnal blood pressure and heart rate associated with hyperinsulinemia may be a harbinger of hypertension-related insulin resistance and may contribute to heightened cardiovascular risk associated with this condition.

Abdilla N, Tormo MC, Fabia MJ, Chaves FJ, Saez G, Redon J. · Hypertension Clinic, Hospital Clínico, University of Valencia, Valencia, Spain. · J Hum Hypertens. · Pubmed #17066087 No free full text.

Abstract: The objective of the present study was to analyze the impact of metabolic syndrome (MS) and its individual components on oxidative stress (OX) and on the activity of antioxidant enzymes of patients with essential hypertension. One hundred and eighty-seven hypertensives, 127 (61.9%) of them having criteria for MS according to the International Diabetes Federation criteria and 30 healthy normotensive subjects were included. OX status was assessed by measuring glutathione oxidized/glutathione reduced and reactive oxygen species-induced byproducts of lipid peroxidation, malondialdehyde, and DNA damage, 8-oxo-dG genomic and mitochondrial. Antioxidant enzymatic activity of Cu/Zn extracellular-superoxide dismutase (SOD) and catalase (CAT) was measured in plasma and glutathione peroxidase 1 in hemolysed erythrocytes. In mononuclear cells, total-SOD activity, CAT and glutathione peroxidase 1, were assessed as well. The OX state in both blood and peripheral mononuclear cells observed in hypertensives were not enhanced by the addition of components of the so-called MS. Likewise, the reduction in the activity of antioxidant enzymes, both extracellular and cytoplasmic, was not affected by the presence of additional components of the MS. Neither the number of components nor the individual addition of each of them, low high-density lipoprotein, triglycerides, abdominal obesity or fasting glucose, further impact in the OX abnormalities observed in those with only hypertension in absence of other components. In conclusion, the present data indicates that contribution of MS components to the OX burden generated by high blood pressure is minimal.

Lurbe E, Invitti C, Torro I, Maronati A, Aguilar F, Sartorio A, Sartorio G, Redon J, Parati G. · Pediatric Nephrology and Cardiovascular Risk Unit, Consorcio Hospital General, University of Valencia, Recava, Spain. · J Hypertens. · Pubmed #16877958 No free full text.

Abstract: OBJECTIVES: Obesity is an increasingly frequent problem among children and adolescents, and may lead to blood pressure (BP) increase. The aim of the present study was to assess the prevalence of hypertension, white-coat and masked hypertension in obese adolescents making systematic use of both office BP and 24-h ambulatory BP measurement. The impact of different degrees of obesity on BP and heart rate variability was also investigated. METHODS: Office and ambulatory BP were obtained in 285 overweight and obese Caucasian adolescents (11-18 years old) and in 180 age- and sex-matched controls. The extent of obesity was quantified using body mass index z score. RESULTS: A significant positive relationship between body mass index z score and both office and ambulatory systolic BP was found after adjusting for age and height in both boys and girls. Obese youths had not only higher BP levels, but also higher BP variability compared with controls. Among obese youths, 20.8% had abnormal BP conditions, 6.6% were white-coat hypertensives, 9.2% were masked hypertensives and 5% were sustained hypertensives. CONCLUSIONS: The prevalence of these abnormal BP conditions, which can be identified thanks to ambulatory BP monitoring, further emphasizes the usefulness of this diagnostic tool in obese youths.