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ΠΑΧΥΣΑΡΚΙΑ ΥΠΕΡΤΑΣΗ ΚΑΙ ΚΑΡΔΙΑΓΓΕΙΑΚΟΣ ΚΙΝΔΥΝΟΣ

ΠΑΧΥΣΑΡΚΙΑ ΥΠΕΡΤΑΣΗ ΚΑΙ ΚΑΡΔΙΑΓΓΕΙΑΚΟΣ ΚΙΝΔΥΝΟΣ. ΑΝΔΡΕΑΣ ΠΙΤΤΑΡΑΣ MD. Hypertension at age 15 Type 2 DM at age 23 Renal failure at age 32 First MI at age 35 (survives) CHF at age 37 Second MI at age 40. 10. 7-11 years. 9. 14-17 years. 18. 15. 27. 17. 25. 12. 12. 11. 16. 18.

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ΠΑΧΥΣΑΡΚΙΑ ΥΠΕΡΤΑΣΗ ΚΑΙ ΚΑΡΔΙΑΓΓΕΙΑΚΟΣ ΚΙΝΔΥΝΟΣ

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  1. ΠΑΧΥΣΑΡΚΙΑ ΥΠΕΡΤΑΣΗ ΚΑΙ ΚΑΡΔΙΑΓΓΕΙΑΚΟΣ ΚΙΝΔΥΝΟΣ ΑΝΔΡΕΑΣ ΠΙΤΤΑΡΑΣ MD

  2. Hypertension at age 15 Type 2 DM at age 23 Renal failure at age 32 First MI at age 35 (survives) CHF at age 37 Second MI at age 40

  3. 10 7-11 years 9 14-17 years 18 15 27 17 25 12 12 11 16 18 18 13 17 8 9 12 19 22 26 20 17 17 18 36 34 17 33 21 31 22 34 35 27 33 23 Overweight (%) Equivalent to BMI>25 © IOTF 2004. IOTF-Cole et al definition of overweight

  4. High Blood Pressure High BMI WORLD Attributable Mortality in 2000 by Selected Leading Risk Factors › Number of Deaths (in thousands) Ezzati et al. Lancet. 2002;360:1347-1360

  5. Obesity is associated with an increased prevalence of hypertension 40 men women 30 % of population 20 10 0 <25 25-26 27-29 30 BMI NTFPTO, Arch Intern Med 2000; 160: 898-904

  6. FEMALES MALES Normal-weight Overweight Obese Proportion of hypertensive patients in different BMI categories in Finland in 1997 (population-based survey) Kastarinen et al., J Hypertens 2000;18:255-262

  7. Normal Obese Hypertensive Obese plus Hypertensive 70 MEN WOMEN 50 % 30 10 Obesity, Hypertension and LV GeometryPrevalence of LVH Kuch et al., J Hum Hypertens 1998;12:685-91

  8. Obesity and HeartSystolic and diastolic function • 50 obese subjects twice ideal body weight echocardiography • Exclusion criteria: hypertension, organic heart disease, congestive heart failure. Alpert, M.A. et al. Int. J. Obes. 1995; 19: 550-557.

  9. Congestive Heart Failure (CHF) and Obesity Framingham Study: 5881 M & W, mean age 55 yrs, 14 years follow-up Kenchman S, Evans J, Levy D et al. Obesity and the risk of heart failure. NEJM 2002;347:305-313

  10. Obesity increases Risk for Diabetes Most BMI >35 vs < 22 kg/m2 Males Females 77,690 females and 46,060 males adjusted for age, smoking, race, 10-year risk 50 41.2 30.1 30 5 4.2 3.7 4 3.3 Odds Ratio 2.9 2.4 3 1.7 BMI <22.0 2 1 0 Gallstones  BP Coronary Disease Diabetes Field et al, Archives Internal Medicine 2001

  11. Prevalence Map of RCA Lesions in Young Men - 3002 subjects studied at autopsy, aged 15 -34 McGill HC et al. Circulation 2002;105:2712-2718

  12. High BMI increases Risk of Cardiovascular Mortality Women (n=98539) Men (n=25736) 4 Aged 45-54, never-smokers 3 2 Relative risk of CV death 1 0 <19 19-21.9 22-24.9 25-26.9 27-28.9 29-31.9 32 BMI Stevens J, N Engl J Med 1998;338(1):1-7

  13. Life expectancy at age 40: Impact of excess body weight Framingham Heart Study 2 Normal 18.5–24.9 kg/m 2 Overweight 25 – 29.9 kg/m 50 2 Obese 30 kg/m 3.3 y 7.1 y 45 46.3 3.1 y 5.8 y Life expectancy (years) 43.4 43.0 40 40.3 39.2 37 5 . 35 Female non-smoker Male non-smoker Peeterset al. Ann Intern Med, 2003

  14. Sodium and volume retention Activation of sympathetic nervous system Inflammation Oxidative stress Renal dysfunction VisceralObesity Insulin and leptin resistance Endothelialdysfunction Activation of renin-angiotensin system Mechanisms linking obesity to hypertension

  15. CONTROL OSA

  16. OBSTRUCTIVE SLEEP APNEA MSNA Respirogram OSA OSA OSA OSA OSA 250 125 BP 0 10 s Somers V.K., Dyken M.E., Clary M.P., Abboud F.M. J. Clin. Invest. 1995, 96: 1897-1904

  17. Cumulative incidence of fatal CV events Percentage Follow-up (months) Marin JM et al. Lancet 2005

  18. Extraordinarily high prevalence of unrecognized sleep apnea in drug-resistant hypertension (3 or more antihypertensive drugs, titrated to maximal dose) MALES FEMALES 65% 97% Logan et al, J Hypertens 2001; 19: 2271-7.

  19. Factors influencing prognosisESH/ESC guidelines 2003 M, men; W, women; LDL, low-density lipoprotein; HDL, high-density lipoprotein; LVMI, left ventricular mass index; IMT, intima-media thickness. Lower levels of total and LDL-cholesterol are known to delineate increased risk, but they were not used in the stratification

  20. Hypertension as a predictor of obesity NBP - normotensives B-HBP - borderlline hypertensives B-HBP - hypertensives Kannel et al., Ann Intern Med. 1967;67:48–59; Julius et al., Hypertension 2000;5:807-813

  21. OBESITY HYPERTENSION Obesity and Hypertension:a 2-way Street ? Obese subjects are prone to hypertensionHypertensives are prone to weight gain Julius, Palatini Hypertension 2000;5:807-813

  22. Conclusions 1. Obesity is the most important risk factor for the development of hypertension 2. Adipose tissue may be directly involved in the pathogenesis of hypertension and increased cardiovascular risk 3. Sleep apnea may contribute to elevated levels of blood pressure in a large proportion of obese hypertensives

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