Is Obesity the New Hypertension? Parallels in the Evolution of Obesity and Hypertension as Recognized Disease States.

Obesity and hypertension are recognized disease states that share many similarities including complex physiology, therapeutic response to both lifestyle modification and pharmacotherapy, and the need for long-term management. Both were initially believed to be disorders of lifestyle rather than true disease entities, and initial efforts at developing medical and surgical therapies were criticized. Ultimately, both have proven to be amenable to treatments that control their underlying physiology. Both hypertension and obesity have complex pathophysiology involving multiple regulatory pathways that may require combination therapies in addition to lifestyle modification to reach therapeutic goals. While hypertension is now a mature field practiced widely in primary care with the availability of 127 antihypertensive drugs, the specialty of obesity medicine is still in its infancy and growing in terms of management and development of medications, devices, and minimally invasive surgical interventions. Although the medical antiobesity armamentarium is relatively limited at present to six FDA-approved drugs, the development of combination pharmacotherapies with lower doses of component agents has improved efficacy and tolerability. As we look to the future of obesity medicine, hypertension can be used as a template to educate the public, fund research, and develop further treatment strategies.