Tuesday, January 26, 2010

Obesity Drives Hypertension Epidemic in the Young

Yesterday, the Heart and Stroke Foundation of Canada released a report titled “A Perfect Storm” in which they present an alarming increase in hypertension and other cardiovascular risk factors in young adults.

According to this report, currently over 160,000 Canadians aged 20-30 and over 340,000 Canadians aged 35-44 are hypertensive.

This should really not come as a surprise, as the same report states that currently 40.5% or 2,5 million 20-30 year olds and 51.5% or another 2.4 million 35-44 year olds are overweight or obese.

Why, given these obesity numbers, does this increase in hypertension not surprise me in the least?

Because, as someone who has extensively worked on the relationship between excess weight and blood pressure, I am only all too familiar with the profound effect that overweight and obesity can have on blood pressure – especially in the young!

Thus, as we reported in a paper that was published back in 2004 in the American Journal of Hypertension, overweight and obesity are indeed the primary drivers of hypertension in the young.

In this cross-sectional study of 45,125 unselected consecutive primary care attendees in a representative nationwide sample of 1912 primary care physicians in Germany, we not only found that blood pressure levels were consistently higher in obese patients (increasing from 34.3% in normal weight to 60.6% in overweight, and well over 70% in obese individuals), but that this increase was also associated with markedly poorer blood pressure control rates (odds-ratio for good blood pressure control in diagnosed and treated patients was 0.8 in overweight and as low as 0.5 in obese patients).

However, even more relevant to yesterday’s report, was the clear finding that the younger the patients, the greater the impact of excess weight on their blood pressure.

As seen in the figure (click figure to enlarge), while in patients older than 60 years, there was little impact of BMI class on hypertension prevalence, in younger patients, there was a steep and consistent increase in hypertension rates with increasing BMI.

This is not surprising, when we look at the pathophysiology of hypertension, which in older individuals is driven almost entirely by stiffening of arteries and an increase in peripheral resistance (or in other words “aging”), while in younger individuals hypertension is driven mainly by the increased sympathetic activity, volume expansion, and increased cardiac output typically associated with excess weight.

Let us not forget that the prevalence of diabetes in the young (over 66,000 in 20-30 year olds and over 130,000 in 35-44 year olds according to the report) is also virtually entirely driven by overweight and obesity.

If all of this is not enough to get us to focus all our efforts on preventing and treating overweight and obesity, I don’t know what is.

If we want to prevent hypertension and diabetes in the young, we need to prevent overweight and obesity.

If we want to treat hypertension and diabetes in the young, we need to treat overweight and obesity.

It is that simple!

AMS
Edmonton, Alberta.

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4 Responses to “Obesity Drives Hypertension Epidemic in the Young”

  1. Paul Boisvert says:

    Arya, Your data presented on hypertension per age group are very high and in contrast with recent data presented from Stats can
    http://www40.statcan.gc.ca/l01/cst01/health03b-eng.htm

  2. Arya M. Sharma, MD says:

    Paul, Actually these number are not high, because these are patients in doctor’s practices and not the general population. The prevalence of hypertension, diabetes, and even overweight and obesity are much higher in people going to see their doctors than in the general public.

    Hope this clarifies these figures.

    a

  3. Gaylene Halter says:

    Hi Dr. Sharma
    I found your research very interesting and would like to add some of
    my thoughts for future research.
    What I have noted is that in the 1960’s sports programs associated to
    junior and senior high schools encouraged participation. These people
    have grown up to continue to enjoy staying fit. These programs were
    initially brought into force in order to encourage hi-needs students
    to play sports versus getting into trouble.
    What has happened since this time is that schools have continued to
    grown in size – because of economic efficiency and program services.
    Once a high school becomes larger than 700 students, teachers are
    unable to get to know the students and their needs. There are too
    many students for all who want to be on a school team or other extra
    curricular program to be involved. Thus, students do not feel a
    connection to the school and are more likely to drop out.
    In addition, sports have become elitist – too much pressure to be the
    best. Students who are not that good or have uninvolved parents (or
    poor parents) can not participate in school based or community based
    fitness programs. It is the lack of learning to enjoy sports between
    the ages of 10 and 18 which leads to uninvolved, unfit and obese
    adults. There are other factors as well such as parental fear for
    children’s safety which has contributed. This fear has parents
    prohibiting children from play in the neighbourhood unless they are
    directly supervised.
    Recently the Alberta government set aside more physical education time
    in the school system to encourage fitness. I do not think this will
    make a difference. I would like to see junior and senior high schools
    become smaller and offer school based sports programs for all the
    students who come out to tryouts. Teachers would say that they are
    overworked and can not do this. But, maybe if schools were smaller
    and sports were viewed as fun and social rather than elitist, students
    participation levels in fitness would improve.
    I would love to do research on this topic. Even just comparing the
    results of fitness activity between larger and smaller school schools
    would provide insight.
    I am presently working on my dissertation research in environmental sociology.
    Sincerely,

    Gaylene Halter,
    Doctoral Student,
    Faculty of Agricultural, Life and Environmental Sciences,
    Department of Rural Economy,
    University of Alberta, Edmonton.

  4. Anonymous says:

    As a kid I hated school sports, especially those involving flying projectiles like balls and shuttlecocks and pucks, or trying to do faster something I’d rather not do at all like run around a track.

    I did – and still do – love to dance. Dancing not only gives me exercise, it makes me happy.
    I have a friend who doesn’t play sports and detests dancing, but he likes to build things. Lugging 4×8 ft plywood and mixing concrete not only gives him exercise, it makes him happy – and productive.

    “Exercise” isn’t synonymous with “sports”.
    Schools could reach kids who don’t like sports by offering dancing (real dancing, not just monotonous exercises set to a sound track), or a chance to learn and do productive physical work they enjoy.

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