2023+OMA临床实践声明:肥胖和高血压.pdf
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1、Obesity Pillars 8(2023)100083Available online 7 August 20232667-3681/2023 The Authors.Published by Elsevier Inc.on behalf of Obesity Medicine Association.This is an open access article under the CC BY-NC-ND license(http:/creativecommons.org/licenses/by-nc-nd/4.0/).Obesity and hypertension:Obesity me
2、dicine association(OMA)clinical practice statement(CPS)2023 A R T I C L E I N F O Keywords Adiposopathy High blood pressure Hypertension Obesity A B S T R A C T Background:This Obesity Medicine Association(OMA)Clinical Practice Statement(CPS)provides an overview of the mechanisms and treatment of ob
3、esity and hypertension.Methods:The scientific support for this CPS is based upon published citations,clinical perspectives of OMA authors,and peer review by the Obesity Medicine Association leadership.Results:Mechanisms contributing to obesity-related hypertension include unhealthful nutrition,physi
4、cal inac-tivity,insulin resistance,increased sympathetic nervous system activity,renal dysfunction,vascular dysfunction,heart dysfunction,increased pancreatic insulin secretion,sleep apnea,and psychosocial stress.Adiposopathic factors that may contribute to hypertension include increased release of
5、free fatty acids,increased leptin,decreased adiponectin,increased renin-angiotensin-aldosterone system activation,increased 11 beta-hydroxysteroid dehydrogenase type 1,reduced nitric oxide activity,and increased inflammation.Conclusions:Increase in body fat is the most common cause of hypertension.A
6、mong patients with obesity and hypertension,weight reduction via healthful nutrition,physical activity,behavior modification,bariatric sur-gery,and anti-obesity medications mostly decrease blood pressure,with the greatest degree of weight reduction generally correlated with the greatest degree of bl
7、ood pressure reduction.1.Introduction Beginning in 2013,the Obesity Medicine Association(OMA)created and maintained an Adult“Obesity Algorithm”(i.e.,educational slides and eBook)that underwent yearly updates by OMA authors and was reviewed and approved annually by the OMA Board of Trustees 1.This cu
8、rrent OMA Clinical Practice Statement(CPS)regarding obesity and hypertension was derived from extensive updates to the content of the 2021 OMA Adult Obesity Algorithm.This CPS is one of a series of OMA CPSs designed to assist clinicians in the care of their patients with the disease of obesity.2.Obe
9、sity and high blood pressure/hypertension Hypertension can be defined as arterial blood pressure readings that,when persistently elevated above ranges established by medical orga-nizations,adversely affect patient health 2.For this discussion,high blood pressure refers to the physiologic measurement
10、 of the blood flow force on arteries,while hypertension refers to the disease of persistent high blood pressure.2.1.Blood pressure measurements Blood pressure measurements can be affected by many factors.A key for potentially actionable longitudinal assessment and treatment of high blood pressure is
11、 consistency in how blood pressure is measured,with recognition that blood pressure can be affected by:White-coat hypertension:Some patients may experience an increase in blood pressure due to anxiety and stress before and dur-ingencounters with the clinician.Such patients may benefit from home bloo
12、d pressure(BP)monitoring and/or ambulatory BP moni-toring(ABPM)2.Masked hypertension:Some patients have normal blood pressure measurements in the clinician office,but elevated blood pressure upon ambulatory blood pressure monitoring or home blood pressure monitoring.Patients with masked hypertension
13、 are at risk for car-diovascular disease 3.Overstimulation:Patients should avoid caffeine,energy drinks,de-congestants,physical exercise,stressful situations,full bladder,and/or smoking for at least 30 minutes prior to BP measurement.For example,if a patient arrives to the medical office after exper
14、iencing frustration due to anxiety-producing traffic,then the patient should be given the opportunity to calm down in a quiet room for 30 mi-nutes or longer.Patients with full bladder,4 and/or who feel the need to urinate,may have increased blood pressure and should void prior to having blood pressu
15、re taken.Some patients with acute pain(e.g.,immediately after a phlebotomy stick)or discomfort may also experience transient increased blood pressure;the high blood Contents lists available at ScienceDirect Obesity Pillars journal homepage: https:/doi.org/10.1016/j.obpill.2023.100083 Received 6 Augu
16、st 2023;Accepted 6 August 2023 Obesity Pillars 8(2023)1000832pressure due to acute pain should resolve once the pain and/or discomfort resolves.On first measurement date,blood pressure should optimally be measured in both arms by repeated values separated by at least 1 min,with a record of the value
17、s and respective arms(left and right).Longitudinally,future BP measurement might best be measured on the same arm previously recorded as having the highest BP measurement.Patients should have clothing removed from the arm,be seated with feet flat on the floor(i.e.,not crossed),relaxed and quiet for
18、510 minutes prior to BP measurement.Crossed legs may increase blood pressure 5.During the BP measurement,the patient should not talk,nor should the patient be asked questions(including medical questions)during the time blood pressure is being assessed.Blood pressure should be obtained by trained med
19、ical personnel using a properly validated and calibrated blood pressure measure-ment device.The cuff should be placed on around the skin of the upper arm(i.e.,not over clothing).The cuff type and size should be appropriate for the patient arm size 6.If blood pressure is taken by a manual cuff(i.e.,s
20、phygmomanometer):o The cuff should be placed one inch above the elbow bend,with the center of the cuff(often identified with a marker)aligned with the brachial artery,as found by palpation.o The cuff should be inflated until the radial pulse is no longer felt.o The cuff is then slowly deflated until
21、 the pulse is felt again.This number reading(mmHg)on the mercury column is the approxi-mate systolic blood pressure.o After deflating the cuff,and after waiting another 15 seconds,the bell of the stethoscope is placed over the brachial artery.o The cuff is then inflated 30 mmHg above the previous sy
22、stolic blood pressure reading.o The cuff is then deflated(again)at 2 mmHg per second or beat.o The first of at least two regular beats is the systolic blood pressure.o When the beat disappears entirely,this is the diastolic blood pressure.o After obtaining BP readings,the cuff should be deflated,rem
23、oved,and the systolic and diastolic BP should be recorded(in mmHg)immediately.2.2.Differential diagnosis of hypertension Among the more important considerations in evaluating high blood pressure in patients with obesity is ensuring an accurate diagnosis.While the adiposopathic effects of increased b
24、ody fat are the most common cause of hypertension,simply because a patient has obesity does not negate the need to be mindful of other potential secondary causes that include 7:Pheochromocytoma Primary hyperaldosteronism Hypercortisolism Hyperthyroidism Renal artery stenosis Kidney diseases Side eff
25、ects of concomitant therapies Familial or genetic syndromes That said,overweight and obesity clearly increases the risk of hy-pertension 810.As with obesity itself,hypertension is a chronic dis-ease that represents a major risk factor for cardiovascular disease(CVD),which is the most common cause of
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