title: Reduction in resting metabolic rate and ratio of plasma leptin to urinary nitric oxide: influence on obesity-related hypertension.
abstract: BACKGROUND
  Multiple factors are involved in the pathogenesis of hypertension in the obese individual
  
  
  OBJECTIVE
  To evaluate the role of a decrease in sympathetically mediated thermogenesis and the effect of the correlation between the plasma leptin and daily urinary nitric oxide levels on obesity-related hypertension.
  
  
  METHODS
  We evaluated three groups: 25 obese hypertensive patients (age 45.7 +/- 1.37 years, body mass index 34.2 +/- 1.35 kg/m2, systolic/diastolic blood pressure 155 +/- 2.9/105 +/- 1.3, mean arterial pressure 122 +/- 1.50 mmHg); 21 obese normotensive patients (age 39.6 +/- 1.72, BMI 31.3 +/- 0.76, SBP/DBP 124 +/- 2.1/85.4 +/- 1.8, MAP 98.2 +/- 1.80); and 17 lean normotensive subjects (age 38.1 +/- 2.16, BMI 22.1 +/- 0.28, SBP/DBP 117 +/- 1.7/76.8 +/- 1.5, MAP 90.1 +/- 1.50). We determined basal resting metabolic rates, plasma insulin (radio-immunoassay), norepinephrine (high performance liquid chromatography) in all subjects. Thereafter, 14 obese hypertensives underwent a weight reduction diet. At weeks 6 (n = 14) and 14 (n = 10) of the diet the above determinations were repeated. Plasma leptin (enzyme-linked immunosorbent assay) and UNOx (spectrophotometry) were assayed in 17 obese hypertensives and 17 obese normotensives, and in 19 obese hypertensives versus 11 obese normotensives, respectively.
  
  
  RESULTS
  Obese hypertensive patients had significantly higher basal RMR and plasma NE levels insulin levels were lower in the lean group, with no difference between the hypertensive and normotensive obese groups. At weeks 6 and 14, BMI was significantly lower, as were insulin and NE levels. RMR decreased to values of normotensive subjects. MAP normalized but remained significantly higher than in obese normotensives. Leptin blood levels and the leptin/UNOx ratio were significantly higher in the obese hypertensive compared to the obese normotensive patients. Both these parameters were strongly correlated to BMI, MAP, RMR, and plasma NE and insulin. Obese hypertensive patients excreted less urinary NO metabolites. A strong correlation was found between MAP and the leptin/UNOx ratio.
  
  
  CONCLUSIONS
  A reduction in sympathetically mediated thermogenesis, as reflected by RMR, results in normalization of obesity-related hypertension. In contrast, insulin does not seem to play a major role in the pathogenesis of hypertension associated with obesity. Increased leptin levels in conjunction with decreased NO production in the presence of enhanced sympathetic activity may contribute to blood pressure elevation in the obese.
authors.affiliation: Department of Nephrology and Hypertension, Meir Hospital, Kfar Saba, Israel. golanel@clalit.org.il
authors.forename: Eliezer
authors.initials: E
authors.lastname: Golan
authors.forename: Bruria
authors.initials: B
authors.lastname: Tal
authors.forename: Yossef
authors.initials: Y
authors.lastname: Dror
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Korzets
authors.forename: Yaffa
authors.initials: Y
authors.lastname: Vered
authors.forename: Eliyahu
authors.initials: E
authors.lastname: Weiss
authors.forename: Jacques
authors.initials: J
authors.lastname: Bernheim
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001481:Basal Metabolism / Q000502:physiology*; D002851:Chromatography, High Pressure Liquid; D004038:Diet, Reducing; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000378:metabolism*; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000652:urine*; D009638:Norepinephrine / Q000097:blood; D009765:Obesity / Q000150:complications / Q000378:metabolism* / Q000517:prevention & control; D011863:Radioimmunoassay
chemical_list: D007328:Insulin; D020738:Leptin; D009569:Nitric Oxide; D009638:Norepinephrine