Cardiovascular risk in overweight/obese and lean hypertensive patients

Obesity and hypertension have been identified as independent risk factors for cardiovascular disease. Nevertheless, the role of obesity in the development and progression of target-organ disease in hypertensive patients is controversial. The objective of this study was to assess the impact of body weight on cardiovascular risk factors, target-organ disease and global cardiovascular risk in hypertensive patients in a primary care setting. A cross-sectional observational study was carried in Vila Nova de Gaia, Portugal (n=150). A detailed medical and personal history was obtained and a physical examination was performed. Venous blood and 24-hour urine samples were collected, and an electrocardiogram was performed. Cardiovascular risk was assessed using the Framingham score. The statistical analysis was performed using SPSS®. A p-value <0.05 was considered statistically significant. The sample was 71.8% female, with a mean age of 74.3±10.8 years. The prevalence of obesity was 29.5%. Overweight/obese subjects presented lower mean HDL cholesterol (51.2±13.9 mg/dl vs. 65.4±35.2, p<0.005), higher triglycerides (137.8±70.4 mg/dl vs. 111.5±68.8 mg/dl, p<0.001), higher fasting glucose (111.9±32.8 mg/dl vs. 98.4±13.1 mg/dl, p<0.011) and more frequent mild valve disease (57.9% vs. 29.6%, p=0.021). Global cardiovascular risk was also significantly higher (10.9±7.7 vs. 6.5±5.7, p<0.001). Overweight and obesity appear to be related to a less favorable lipid and blood glucose profile and higher cardiovascular risk in hypertensive patients. On the basis of our findings we suggest strict metabolic monitoring and improved education on weight reduction and control at primary health care clinics. A obesidade e a hipertensão arterial são fatores de risco independentes para a doença cardiovascular. No entanto, o papel da obesidade no desenvolvimento da doença de órgão-alvo em pacientes hipertensos tem sido altamente controverso. O objetivo deste estudo é avaliar o efeito da sobrecarga ponderal (excesso de peso ou obesidade [OW/Ob]) sobre outros fatores de risco, doença de órgãos-alvo e risco cardiovascular global, em pacientes hipertensos. Estudo observacional, transversal, realizado em Vila Nova de Gaia, Portugal (n=156). A história clínica foi colhida e avaliação física realizada, que incluiu uma amostra de sangue venoso, urina de 24-horas e eletrocardiograma. O risco cardiovascular foi avaliado pelo score de Framingham. A análise estatística foi realizada com SPSS®, considerando-se um valor de p<0,05 como estatisticamente significativo. A amostra apresenta uma idade média de 74,3±10,8 anos (71,8% mulheres). A prevalência de obesidade foi de 29,5%. O Grupo OW/Ob apresentou valores inferiores de HDL-colesterol, (51,2±13,9 mg/dl versus 65,4±35,2, p<0,005) e superiores de triglicerídeos (137,8±70,4 mg/dl versus 111,5±68,8 mg/dl, p<0,001) e glucose em jejum (111,9±32,8 mg/dl versus 98,4±13,1 mg/dl, p<0,011). A valvulopatia ligeira foi mais frequente neste grupo (57,9% versus 29,6%, p=0,021), e o risco cardiovascular global mais elevado (10,9±7,7 versus 6,5±5,7, p<0,001). O excesso de peso e a obesidade parecem estar associados a um maior risco cardiovascular nos doentes hipertensos. Um adequado controlo metabólico e melhor educação para a saúde deverão ser integrados na abordagem multidisciplinar deste grupo de risco.