Ninaad Sindhwani, Pyush Moudgil, Jatin Thukral, Riya Kaushal Shah, Harbir Kaur, Rajat Kumar, Nikhil Thukral, Maharshi Raval, Siddharth Pravin Agrawal, William H. Frishman, Wilbert S. Aronow
Obesity and hypertension are interdependent chronic conditions that substantially elevate global cardiovascular risk. Rising obesity prevalence has led to a parallel increase in hypertension, driven by complex physiological disturbances that extend beyond excess body weight alone. This review synthesizes current evidence on the mechanisms linking adiposity to blood pressure elevation, emphasizing the roles of sympathetic nervous system overactivity, insulin resistance, renal sodium retention, and adipose-derived hormonal and inflammatory dysregulation. Particular attention is given to visceral adiposity, which exerts adverse vascular, renal, and metabolic effects that accelerate development of hypertension-mediated organ damage, including left ventricular hypertrophy, arterial stiffness, and early renal injury. The manuscript also evaluates therapeutic strategies for obesity-related hypertension. Lifestyle interventions-caloric restriction, structured physical activity, and behavioral therapy-remain the cornerstone of management, producing clinically meaningful reductions in body weight and blood pressure. However, sustained weight loss is difficult for many individuals, necessitating adjunctive approaches. Contemporary pharmacotherapies, particularly glucagon-like peptide-1 receptor agonists such as semaglutide, have demonstrated substantial benefits in both weight reduction and blood pressure control. For patients with severe obesity or inadequate response to medical therapy, metabolic and bariatric procedures offer the most durable outcomes, improving cardiometabolic profiles and reducing antihypertensive medication burden.