Hypertension in children with obesity

Abstract

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 mechanisms 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 co-morbid 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.

Keywords: Hypertension, Obesity, Children, Birth weight, Sympathetic nervous system, Hormone, Kidney, Sodium, Vitamin D, Uric acid

Core tip: The obesity epidemic in children is beginning to show its ramifications of increase in chronic diseases in children such as hypertension. Early childhood factors like prematurity and accelerated post-natal weight gain play a role in hypertension in later years and shed light on the multi-factorial prevention strategies that need to be in place. Furthermore, surveillance of factors such as vitamin D deficiency, hyperuricemia, sleep apnea, chronic kidney disease and fatty liver is required in addition to the traditional approach of weight management and pharmacotherapy.