Obesity, hypertension and heart disease: A complex relationship

Along with type 2 diabetes, dyslipidemia and thrombosis, the cardiometabolic diseases of obesity, hypertension and heart disease form a complex triad that poses significant risks to the health of individuals.

These interrelated complications of obesity often share similar risk factors, compounding their adverse effects and creating challenges for both patients and their treating clinicians. Understanding the relationship between obesity, hypertension and heart disease is key in developing effective prevention strategies and treatments to mitigate their adverse impact on patients.

Obesity, hypertension and heart disease are individually among the leading diseases encountered in clinical practice, and collectively, they are among the most common causes of increased morbidity and mortality. Their shared risk factors often include genetic predisposition, unhealthful nutrition, physical inactivity and environmental influences. Obesity also often directly and indirectly contributes to the pathogenesis of other major cardiometabolic risk factors, such as type 2 diabetes, thrombosis, and hypertension.

From a pathogenic standpoint, an increase in body fat (adipose tissue) can result in “fat mass disease,” which includes biomechanical abnormalities that directly and adversely affect the heart and blood vessels. Additionally, an increase in adiposity can contribute to “sick fat disease” (ie, adiposopathy), where inflammatory and hormonal abnormalities arising from increased body fat can exacerbate major cardiovascular risk factors such as type 2 diabetes, hypertension, dyslipidemia and thrombosis. Adiposopathic immune and endocrine responses from epicardial fat are increasingly recognized as a potentially important direct cause of heart disease.

Understand genetic risks, avoid blame

All these cardiometabolic diseases often have strong genetic components. Understanding the connection between genetic predisposition and cardiovascular health helps unveil the complex landscape where polygenetic makeup contributes to the common clinical clustering of obesity, type 2 diabetes, hypertension, dyslipidemia, thrombosis, heart disease, and even cancer. That said, some of the most severe cases of these diseases are due to specific genetic abnormalities. Therefore, when encountering a patient with obesity, clinicians should avoid the temptation to automatically “blame” the patient and conclude that the cardiometabolic diseases found in a patient with obesity are always solely due to obesity. Just as in patients without obesity, specific genetic abnormalities can play a role as well, and often a significant one. Recognizing the role of genetic predispositions alongside lifestyle factors is crucial in developing effective prevention and management strategies for cardiometabolic diseases. Having clinicians avoid biased assumptions and dismissing other potential diagnostic possibilities is a recurrent challenge for the patient with obesity. This is especially so for patients with obesity whose body weight is often “blamed” for the many medical ailments they may experience.

Timely intervention

Once a proper diagnosis is made, then the next key to management is early intervention. The longer a patient is exposed to cardiometabolic risk factors such as uncontrolled diabetes, uncontrolled hypertension, uncontrolled dyslipidemia, then the higher the risk for developing heart disease (and cancer). The duration of exposure to these major cardiovascular risk factors plays a crucial role in determining overall cardiovascular risk. This principle extends to obesity as well. The longer an individual has uncontrolled obesity and its accompanying complications — such as hypertension, diabetes, dyslipidemia and predisposition to thrombosis — then the more pronounced the risk for cardiovascular disease becomes. Thus, time is a critical factor in understanding the progression and severity of cardiometabolic diseases, highlighting the importance of timely intervention and comprehensive management strategies to mitigate cardiovascular risks.

Regarding treatment, an optimal obesity management plan includes healthful nutrition, routine physical activity, and behavior modification. Additional interventions often include anti-obesity medications and weight-management bariatric procedures. Given the commonality of pathogenesis and the central role of obesity in contributing to cardiovascular disease, it should be of no surprise that recommendations regarding nutrition, physical activity, medications and bariatric procedures are often similar with regard to treatment of obesity, as well as treatment of type 2 diabetes, hypertension, dyslipidemia, risk of thrombosis, cardiovascular disease and cancer. Among the more notable recent advancements in obesity treatment include semaglutide for obesity, which now has an FDA indication not only for weight management, but also to reduce the risk for cardiovascular disease.

Evidence also supports the benefits of some bariatric procedures in improving cardiometabolic risk factors and reducing cardiovascular disease risk (as well as reduce the risk of cancer). These advancements underscore the need for a multifaceted approach to combating obesity and its associated cardiometabolic risk factors via the integration of evidenced-based nutritional intervention, physical activity, behavior modification, pharmacological interventions and surgical options. Using this “all-the-above” approach, implemented by an integrated obesity management team, affords the best chance for improved outcomes and cardiovascular health.

Available resources

For health care providers treating patients with obesity, heart disease, hypertension and other cardiovascular disease risk factors, the Obesity Medicine Association offers a wealth of resources on this intricate relationship, especially within its many Clinical Practice Statements. By accessing and using these free online resources, health care professionals can gain invaluable insights into evidence-based practices, treatment modalities, and advancements in the field, fostering informed decision-making and improved patient outcomes.

As an example, a recent article published in the Obesity Pillars entitled, “Obesity and hypertension: An OMA clinical practice statement,” provides mechanistic details of how obesity contributes to hypertension, as well as how anti-obesity medications affect blood pressure and heart rate.