HYPERTENSION DIFFERS.

Source: JAMA 2001; 285:1008

Obese people with hypertension are less likely than lean hypertensive people to die prematurely or have heart attacks or strokes. Researchers of the State University of New York, Downstate Medical Center in Brooklyn, say genetics may be responsible. Overweight people have a reduced response of adrenaline and other potentially dangerous stress hormones during physical exercise, while in thin people with hypertension, the involvement of hormones such as adrenaline and renin appears to increase the size of the heart and cause stiffening of the arteries. A study that included 197 volunteers compared 121 patients with hypertension with 76 people whose blood pressure was in the normal range. Of the 121 with hypertension, 55 (47 men and 8 women) were classified as obese. Sixty-six (57 men and 9 women) were classified as lean. The individuals were given two standard treadmill tests and studied for the effects of standing for 10 minutes in an upright position after a treadmill exercise session. Researchers concluded that the cardiovascular properties in lean hypertensive patients are more dependent on catecholamines and the renin system than they are in hypertensive patients who are obese. The different neuroendocrine responses to dynamic stimuli in lean and obese patients may help explain the disparity in cardiovascular outcomes.