Mechanisms of hypertension in the syndromes of obesity.

Evidence is reviewed bearing on the question whether the metabolic derangements associated with some common subtypes of obesity may not be a major contributing cause of the associated hypertension. These derangements include hyperinsulinemia and disturbed carbohydrate metabolism, increased sympathetic nervous activity, and increased activity of thyroid hormones, each of which may enhance renal sodium reabsorption. Recent current clinical trials of pharmacologic and non-pharmacologic management of the overweight hypertensive patient are reviewed with reference to these metabolic derangements.