Obesity and Hypertension

THE PURPOSE of this article is to call attention to a large subgroup of overweight and underexercised hypertensive patients, who probably have hitherto unrecognized mechanisms contributing to their hypertension, and for whom physiological, as opposed to pharmacologic, management may be more effective and appropriate. Two years ago, Dr Louis Tobian1wrote in an editorial on hypertension in the obese: "In our recently heightened zeal to treat hypertensive patients with pressure lowering drugs, we may be overlooking another potent avenue of therapy." He referred to the effects of weight loss alone and concluded that, while it was still not known how adiposity leads to hypertension, the question deserved intensive research. He concluded that the cause of the hypertension in this group was still elusive. We are entering an exciting period in which the underlying mechanisms are becoming clarified. In view of increasing interest in this area, a meeting was convened