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CONTENTS

Abstract .................................................................................................................................. 2

Introduction ............................................................................................................................ 3

Obesity ................................................................................................................................... 3

Dyslipidemia .......................................................................................................................... 3

Hypertension .......................................................................................................................... 4

Discussion .............................................................................................................................. 4

Conclusion ............................................................................................................................. 7

References .............................................................................................................................. 8


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Abstract

Obesity is one of public health problems that is important and growing rapidly nowadays

around the world. It varies by age and sex, and by race-ethnic group. In the United States,

approximately one third of adults are obese and the prevalence of overweight and obesity in

the pediatric population has increased substantially. Obesity adversely affects the majorcardiovascular risk factors. The risk factors are dyslipidemia, hypertension, and type 2

diabetes mellitus. It also increased incidence of other conditions of non cardiovascular such

as non alcoholic fatty liver disease, rheumatoid arthritis, and with an increased risk of

disability. As a consequence, obese persons have an increased risk of death, especially from

cardiovascular disease. Evidence suggests that hypertension may share pathophysiology with

cardiovascular disease. Thus, dyslipidemia, a strong predictor of cardiovascular disease, may

also predict incident hypertension. A lot of studies have prospectively examined the

relationship between plasma lipids and the future development of hypertension. Therefore I

compare some studies to know the correlation between dyslipidemia and hypertension. The

datas suggest that dyslipidemia may lead to the subsequent development of hypertension.

Key words: obesity, dyslipidemia, hypertension, cardiovascular disease.


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Introduction

Obesity is one of public health problems that is important and growing rapidly

nowadays around the world. In the United States, approximately one third of adults are obese

and the prevalence of overweight and obesity in the pediatric population has increased

substantially.1

Obesity adversely affects the major cardiovascular risk factors. The risk

factors are dyslipidemia, hypertension, and type 2 diabetes mellitus. As a consequence, obese

persons have an increased risk of death, especially from cardiovascular disease.2

This paper

will discuss about the correlation between dyslipidemia and hypertension in obese people.

Obesity

Obesity is defined as abnormal excess

fat accumulation in body. The major measure

for obesity is the body mass index (BMI), a

persons weight (in kilograms) devided by the square of the height (in meters).3

Dyslipidemia

Dyslipidemia is elevation of total cholesterol, hypertrigliceridemia, elevated low-

density lipoprotein cholesterol (LDL-C), reduced high-density lipoprotein (HDL-C), and

increased atherogenic index. The diagnosis is by measuring fasting plasma levels of total

cholesterol, triglycerides, and individual lipoproteins.4

Lipoproteins Result (mg/dL) Meaning

Total Cholesterol < 200

200239 240

Desirable

Borderline highHigh

Category Range

Underweight

Normal

Overweight

Obese

< 18,5

18,524,9

2529,9

30


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LDL Cholesterol < 100

100159

160

Optimal

Borderline high

High

HDL Cholesterol < 40

60

Low

High

Triglyceride < 150150199

200

DesirableBorderline high

High

Hypertension

Hypertension is a condition in which the blood pressure is chronically elevated.

Routine measurement is needed to make the diagnosis. The JNC VII classification is used to

know the grades.5

Category Systolic (mmHg) Diastolic (mmHg)

Normal < 120 < 80

Prehypertension 120139 8089

Hypertension

Stage 1

Stage 2

140159

160

9099

100

Discussion

Many articles show that obesity has an adverse effect to body. There will be blood

alteration like elevation of plasma cholesterol and reduced high-density lipoprotein which is

resulting dyslipidemia. This alteration makes the blood become more viscous. The viscous

blood slows the blood flow. Dyslipidemia is one of the main risk factors leading to

atherosclerosis and rigidity of blood vessel by endothelial damage mechanism.6

It is known

that rigid blood vessel combine with the loss of psychological vasomotor activity will

increase the pressure, so hypertension and dyslipidemia are closely interrelated.7

Hypertension and dyslipidemia share many characteristics. They are both risk factors

for cardiovascular disease. They are generally considered to be asymptomatic conditions and


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they require lifetime therapy which may include pharmacotherapy and lifestyle changes such

as dietary modification, weight loss, and exercise. For this reason, one might hypothesis that

hypertension has a correlation with dyslipidemia.8

The study from Akintunde et al. revealed about half of newly diagnosed subjects with

hypertension had either isolated or combined dyslipidemia associated with the hypertension

and the prevalence of dyslipidemia is higher among hypertensive subjects in Nigeria.7

Other study in US was held by McDonald to establish the risk factors for

cardiovascular disease in elderly also found that dyslipidemia is associated with hypertension.

Data collected from participants in the National Health and Nutrition Examination Survey

1999-2004 show the prevalence of hypertension in men is 63% and the dyslipidemia is

60,3%.9

As I wrote before, hypertension and dyslipidemia is one of the risk factors for

cardiovascular disease. Of the numerous factors that contribute to cardiovascular risk,

hypertension and dyslipidemia have strong associations with cardiovascular, and are

prevalent either alone or in combination. The interaction between cardiovascular disease risk

factors is such that the probability of a cardiovascular event is frequently greater in patients

with only moderate blood pressure and cholesterol abnormalities in the presence of additional

risk factors than in patients with isolated marked elevations in blood pressure or cholesterol

levels alone. Moreover, the prevalence of hypertension and hypercholesterolemia increases

with age. This shows the relation of dyslipidemia and hypertension.10

In developed countries, dyslipidemia is more common than hypertension. A recent

analysis of the National Health and Nutrition Examination Survey 1999-2000 data indicated a

prevalence of dyslipidemia of 56% in men and 54% in women. A study conducted in French


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adults younger than 55 years old demonstrated that more than 50% of patients with

hypertension also had dyslipidemia.11

Weight gain increases the tendency for cardiovascular risk factors to cluster in

persons with hypertension. It is investigated the prevalence of hypertension and dyslipidemia

in relation to body mass index using data from NHANES III. In individuals under 60 years of

age, the prevalence of high blood pressure increased with body mass index. Similarly, the

prevalence of dyslipidemia rose with body mass index in both sexes and within all racial or

ethnic groups.11

In the Physicians Health Study, total cholesterol, non-high-density lipoprotein

(HDL)-cholesterol and HDL-cholesterol predicted onset of hypertension in 3110 men without

self-reported hypertension. These findings agree with some of the few prospective studies on

dyslipidaemia and incident hypertension. Thus, hypertension may be a consequence of

dyslipidaemia or closely related metabolic abnormalities. Little is known of the association

between other features of dyslipidaemia, such as apolipoprotein A, apolipoprotein B, or

triglyceride content of the low-density lipoprotein (LDL) or HDL particles, and incident

hypertension. Elevated triglyceride-rich lipoproteins, VLDL, small dense LDL particles and

apolipoprotein B and low HDL cholesterol and apolipoprotein A are characteristic features of

dyslipidaemia in the metabolic syndrome and type 2 diabetes. In addition to reverse

cholesterol transport, HDL cholesterol stimulates nitric oxide (NO) production, inhibits

adhesion of monocytes to endothelium, and has antithrombotic and antioxidant effects. In

contrast, LDL cholesterol and triglycerides may damage the epithelium, impair NO release

and cause endothelial dysfunction. Therefore, dyslipidaemia could cause hypertension by

mechanisms only partly related to obesity and insulin resistance.12


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Conclusion

Dyslipidemia often found in obese people which shows the abnormality cholesterol

level in blood. Increased of plasma cholesterol and atherogenic agents makes the blood

become more viscous and forms plaque in the wall of blood vessel and caused endothelial

damage. The plaque then alters the elasticity of blood vessels turns rigid. This rigidity

increases the pressure in the vessel. A lot of studies have been done to prove the effect of

dyslipidemia to blood vessel. There are epidemiological studies found the correlation

between dyslipidemia and hypertension. From the studies above, it is believed that

dyslipidemia strongly leads to hypertension.


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REFERENCES

1. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al.Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J

Med 2011; 365: 1876-85.

2. Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G, et al.Comparative effectiveness of weight-loss interventions in clinical practice.N Engl

J Med 2011; 365: 1959-68.

3. Centers for Disease Control and Prevention. 2012. Defining overweight andobesity. Available at:http://www.cdc.gov/obesity/adult/defining.html

4. Goldberg AC. 2008. Dyslipidemia. Available at:http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/l

ipid_disorders/dyslipidemia.html

5. Bickley LS, Szilagyi PG. Bates guide to physical examination and history taking.Philadelphia: Lippincott Williams&Wilkins; 2009. p.118.

6. Tavridou A, Manolopoulos VG. Novel molecules targeting dyslipidemia andatherosclerosis. Curr Med Chem 2008; 15: 792-802.

7. Akitunde AA, Ayodele EO, Akinwusi OP, Opadijo GO. Dyslipidemia amongnewly diagnosed hypertensives: pattern and clinical correlates. J Natl Med Assoc

2010; 102: 403-7.

8. Lalonde L, OConnor A, Joseph L, Grover SA. Health-related quality of life incardiac patients with dyslipidemia and hypertension. Quality of Life Research

2004; 13: 793-804.

9. McDonald M, Hertz RP, Unger AN, Lustik MB. Prevalvence, awareness, andmanagement of hypertension, dyslipidemia, and diabetes among United States

adults aged 65 and older.J Gerontol 2009; 64: 256-63.
http://www.cdc.gov/obesity/adult/defining.htmlhttp://www.cdc.gov/obesity/adult/defining.htmlhttp://www.cdc.gov/obesity/adult/defining.htmlhttp://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/lipid_disorders/dyslipidemia.htmlhttp://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/lipid_disorders/dyslipidemia.htmlhttp://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/lipid_disorders/dyslipidemia.htmlhttp://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/lipid_disorders/dyslipidemia.htmlhttp://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/lipid_disorders/dyslipidemia.htmlhttp://www.cdc.gov/obesity/adult/defining.html


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10.Kostis JB. The importance of managing hypertension and dyslipidemia todecrease cardiovascular disease. Cardiovasc Drugs Ther 2007; 21: 297-309.

11.Nash DT. The clinical implications and management of concomitant hypertensionand dyslipidemia. Postgrad Med 2006; 119: 37-45.

12.Laaksonen DE, Niskanen L, Nyyssonen K, Lakka TA, Laukkanen JA, Salonen JT.Dyslypidemia as a predictor of hypertension in middle-aged men. Eur Heart J

2008; 29: 2561-8.

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