Obesity, Hypertension, and Cardiovascular Disease

To the Editor.— The recent report by Bloom et al 1 argues against the hypothesis that obesity may protect certain hypertensive patients against cardiovascular disease. Most of the points are well taken; however, I differ with their jaundiced interpretation of the results of our studies (references 18 to 23 in the report by Bloom et al), which suggests that our studies unanimously the results of the present study, that hypertension is associated with an increased risk of CHD [coronary heart disease] and CVD [cardiovascular disease] in men of all levels of BMI [body mass index] and do not support a protective effect by obesity as suggested by the California and French studies. As is made plain in a recent editorial, 2 our work clearly shows that obesity has a dual effect on cardiovascular pathophysiology in hypertension. As Bloom et al suggest, it certainly does increase left ventricular preload and