摘要
The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity.This pediatric health problem may adversely affect cardiovascular health in adult life.The pathogenesis of hypertension in obese children is not widely understood.We therefore undertake this review to raise public awareness.Early childhood parameters like birth weight and postnatal weight gain may play important roles in risk for obesity and obesity related hypertension later in childhood and adult life.Further information is required to confirm this origin of hypertension so that appropriate measures are taken in the peri-natal period.The role of sympathetic nervous system has now been well established as one of the principle mechanisms involved in obesity related hypertension.The Renin-Angiotensin system,insulin resistance due to obesity and as a part of metabolic syndrome along with imbalance in adipokines such as leptin and adiponectin,cause activation of the sympathetic system,vasoconstriction,endothelial dysfunction and sodium reabsorption among other perturbations.Multi-step interventions targeting these various mech-anisms are required to break the cycle of obesity and metabolic syndrome.Vitamin D deficiency,sleep apnea due to airway obstruction and hyperuricemia may also play a significant role and should not be ignored in its early stages.Obesity is a risk factor for other comorbid conditions like chronic kidney disease and fatty liver which further accentuate the risk of hypertension.Increased awareness is required to prevent,diagnose and treat obesity related hypertension among the pediatric population.
The prevalence of obesity related hypertension has dramatically increased in children with the parallel increase in pediatric obesity. This pediatric health problem may adversely affect cardiovascular health in adult life. The pathogenesis of hypertension in obese children is not widely understood. We therefore undertake this review to raise public awareness. Early childhood parameters like birth weight and postnatal weight gain may play important roles in risk for obesity and obesity related hypertension later in childhood and adult life. Further information is required to confirm this origin of hypertension so that appropriate measures are taken in the peri-natal period. The role of sympathetic nervous system has now been well established as one of the principle mechanisms involved in obesity related hypertension. The Renin-Angiotensin system, insulin resistance due to obesity and as a part of metabolic syndrome along with imbalance in adipokines such as leptin and adiponectin, cause activation of the sympathetic system, vasoconstriction, endothelial dysfunction and sodium reabsorption among other perturbations. Multi-step interventions targeting these various mech-anisms are required to break the cycle of obesity and metabolic syndrome. Vitamin D deficiency, sleep apnea due to airway obstruction and hyperuricemia may also play a significant role and should not be ignored in its early stages. Obesity is a risk factor for other comorbid conditions like chronic kidney disease and fatty liver which further accentuate the risk of hypertension. Increased awareness is required to prevent, diagnose and treat obesity related hypertension among the pediatric population.
基金
Supported by The National Institute of Health U01 DK-3-012 grant
investigator-initiated grants from the Cystinosis Research Foundation and Abbott Laboratories
