Contemporary Strategies for Comorbid Obesity, Hypertension, and Chronic Heart Failure in Primary Care: An Evidence-Based Perspective
DOI:
https://doi.org/10.58676/sjmas.v2i10.98Keywords:
Comorbid Obesity, Chronic Heart Failure, Hypertension Management, Multidisciplinary Approach, Precision MedicineAbstract
Background: The growing prevalence of comorbid obesity, hypertension, and chronic heart failure (CHF) represents a significant public health challenge, particularly in primary care. These conditions create a complex clinical triad that exacerbates cardiovascular risk, worsens prognosis, and increases healthcare burdens. Understanding the multifaceted pathophysiology and adopting evidence-based strategies is essential for improving patient outcomes.
Methods and Materials: This study synthesized data from clinical guidelines, systematic reviews, meta-analyses, and peer-reviewed journal articles, focusing on evidence-based management of obesity, hypertension, and CHF. Sources included PubMed, Cochrane Library, NICE guidelines, and studies on advanced diagnostics, pathophysiology, and emerging therapeutic approaches such as SGLT2 inhibitors and GLP-1 receptor agonists.
Results: The findings highlight the critical role of neurohormonal dysregulation, inflammation, and metabolic derangements in the development of comorbidities. Pharmacological interventions like SGLT2 inhibitors and GLP-1 receptor agonists demonstrated significant cardiovascular and renal benefits, while personalized lifestyle modifications, including diet and tailored exercise regimens, improved outcomes. Furthermore, novel biomarkers and genetic insights enable precision risk stratification and early intervention strategies in primary care.
Conclusion: Integrated, multidisciplinary approaches are essential for managing comorbid obesity, hypertension, and CHF. Combining personalized pharmacotherapy with innovative diagnostics and lifestyle interventions optimizes clinical outcomes, reduces disease progression, and enhances quality of life. Addressing barriers in primary care will further refine the management of these high-risk patients.
References
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M. (2021). Obesity and Cardiovascular Disease: A scientific statement from the American Heart Association. Circulation, 143(21). https://doi.org/10.1161/cir.0000000000000973
Saltiel, A. R., & Olefsky, J. M. (2017). Inflammatory mechanisms linking obesity and metabolic disease. The Journal of Clinical Investigation, 127(1), 1–4. https://doi.org/10.1172/JCI92035
Després, J. (2012). Body fat distribution and risk of cardiovascular disease. Circulation, 126(10), 1301–1313.
https://doi.org/10.1161/circulationaha.111.067264
Li, M., Qian, M., Kyler, K., & Xu, J. (2021). Adipose Tissue-Endothelial Cell Interactions in Obesity-Induced Endothelial Dysfunction. Frontiers in cardiovascular medicine, 8, 681581.
https://doi.org/10.3389/fcvm.2021.681581
Adeva-Andany, M. M., Domínguez-Montero, A., Adeva-Contreras, L., Fernández-Fernández, C., Carneiro-Freire, N., & González-Lucán, M. (2024). Body Fat Distribution Contributes to Defining the Relationship between Insulin Resistance and Obesity in Human Diseases. Current diabetes reviews, 20(5), e160823219824.
https://doi.org/10.2174/1573399820666230816111624
Kalil, G., Haynes, W. Sympathetic nervous system in obesity-related hypertension: mechanisms and clinical implications. Hypertens Res 35, 4–16 (2012). https://doi.org/10.1038/hr.2011.173
Kramer, C. K., von Mühlen, D., & Barrett-Connor, E. (2010). Does leptin predict incident hypertension in older adults? Clinical endocrinology, 73(2), 201–205. https://doi.org/10.1111/j.1365-2265.2010.03781.x
Packer, M. (2018). Leptin-Aldosterone-Neprilysin axis. Circulation, 137(15), 1614–1631. https://doi.org/10.1161/circulationaha.117.032474
Cabandugama, P. K., Gardner, M. J., & Sowers, J. R. (2017). The Renin Angiotensin Aldosterone System in Obesity and Hypertension: Roles in the Cardiorenal Metabolic Syndrome. The Medical Clinics of North America, 101(1), 129–137. https://doi.org/10.1016/j.mcna.2016.08.009
Mitchell, G. F., Hwang, S. J., Vasan, R. S., Larson, M. G., Pencina, M. J., Hamburg, N. M., Vita, J. A., Levy, D., & Benjamin, E. J. (2010). Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation, 121(4), 505–511.
https://doi.org/10.1161/CIRCULATIONAHA.109.886655
Kusche-Vihrog, K., Jeggle, P., & Oberleithner, H. (2014). The role of ENaC in vascular endothelium. Pflugers Archiv : European journal of physiology, 466(5), 851–859. https://doi.org/10.1007/s00424-013-1356-3
Gutiérrez-Cuevas, J., Sandoval-Rodriguez, A., Meza-Rios, A., Monroy-Ramírez, H. C., Galicia-Moreno, M., García-Bañuelos, J., Santos, A., & Armendariz-Borunda, J. (2021). Molecular Mechanisms of Obesity-Linked Cardiac Dysfunction: An Up-Date on Current Knowledge. Cells, 10(3), 629. https://doi.org/10.3390/cells10030629
Shen Q, Hiebert JB, Rahman FK, Krueger KJ, Gupta B, Pierce JD. Understanding Obesity-Related High Output Heart Failure and Its Implications. Int J Heart Fail. 2021 Jul;3(3):160-171. https://doi.org/10.36628/ijhf.2020.0047
Zeng, N., Wang, A., Zhong, C., Zheng, X., Zhu, Z., Xu, T., Peng, Y., Peng, H., Li, Q., Ju, Z., Geng, D., Zhang, Y., & He, J. (2019). Association of serum galectin-3 with risks of death and vascular events in acute ischaemic stroke patients: the role of hyperglycemia. European Journal of Neurology, 26(3), 415–421. https://doi.org/10.1111/ene.13856
Fishman, S. L., Sonmez, H., Basman, C., Singh, V., & Poretsky, L. (2018). The role of advanced glycation end-products in the development of coronary artery disease in patients with and without diabetes mellitus: a review. Molecular Medicine, 24(1). https://doi.org/10.1186/s10020-018-0060-3
Vekic, J., Vujcic, S., Bufan, B., Bojanin, D., Al-Hashmi, K., Al-Rasadi, K., Stoian, A. P., Zeljkovic, A., & Rizzo, M. (2023). The role of advanced glycation end products on dyslipidemia. Metabolites, 13(1), 77. https://doi.org/10.3390/metabo13010077
Smita Pattanaik, Chapter 7 - Biomarkers in essential hypertension, Editor(s): Seema S. Ahuja, Brian Castillo, In Clinical Aspects and Laboratory Determination, Kidney Biomarkers, Academic Press, 2020, Pages 247-288, ISBN 9780128159231, https://doi.org/10.1016/B978-0-12-815923-1.00008-0.
Després, J. (2012b). Body fat distribution and risk of cardiovascular disease. Circulation, 126(10), 1301–1313.
https://doi.org/10.1161/circulationaha.111.067264
Agius, R., Pace, N. P., & Fava, S. (2024). Phenotyping obesity focuses on metabolically healthy obesity and metabolically unhealthy normal weight. Diabetes/metabolism research and reviews, 40(2), e3725. https://doi.org/10.1002/dmrr.3725
Lim, S., & Meigs, J. B. (2014). Links between ectopic fat and vascular disease in humans. Arteriosclerosis, thrombosis, and vascular biology, 34(9), 1820–1826. https://doi.org/10.1161/ATVBAHA.114.303035
Battineni, G., Sagaro, G. G., Chintalapudi, N., Amenta, F., Tomassoni, D., & Tayebati, S. K. (2021). Impact of Obesity-Induced Inflammation on Cardiovascular Diseases (CVD). International Journal of Molecular Sciences, 22(9), 4798. https://doi.org/10.3390/ijms22094798
K., & Grant, S. F. A. (2023). Genetics and epigenetics in the obesity phenotyping scenario. Reviews in endocrine & metabolic disorders, 24(5), 775–793. https://doi.org/10.1007/s11154-023-09804-6
Kraja, A. T., Hunt, S. C., Rao, D. C., Dávila-Román, V. G., Arnett, D. K., & Province, M. A. (2011). Genetics of hypertension and cardiovascular disease and their interconnected pathways: lessons from large studies. Current hypertension reports 13(1), 46–54.
https://doi.org/10.1007/s11906-010-0174-7
Chavira-Suárez, E., Ramírez-Mendieta, A. J., Martínez-Gutiérrez, S., Zárate-Segura, P., Beltrán-Montoya, J., Espinosa-Maldonado, N. C., de la Cerda-Ángeles, J. C., & Vadillo-Ortega, F. (2019). Influence of pre-pregnancy body mass index (p-BMI) and gestational weight gain (GWG) on DNA methylation and protein expression of obesogenic genes in the umbilical vein. PloS one, 14(12), e0226010.
https://doi.org/10.1371/journal.pone.0226010
Soler-Botija, C., Gálvez-Montón, C., & Bayés-Genís, A. (2019). Epigenetic biomarkers in cardiovascular diseases. Frontiers in Genetics, 10. https://doi.org/10.3389/fgene.2019.00950
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M. (2021b). Obesity and Cardiovascular Disease: A scientific statement from the American Heart Association. Circulation, 143(21). https://doi.org/10.1161/cir.0000000000000973
UCSF Health. (2024, July 5). Diet and congestive heart failure. ucsfhealth.org. https://www.ucsfhealth.org/education/diet-and-congestive-heart
Talha, K. M., Anker, S. D., & Butler, J. (2023). SGLT-2 Inhibitors in Heart Failure: A Review of Current Evidence. International Journal of Heart Failure, 5(2), 82–90. https://doi.org/10.36628/ijhf.2022.0030
Fatima, A., Rasool, S., Devi, S., Talha, M., Waqar, F., Nasir, M., Khan, M. R., Ibne Ali Jaffari, S. M., Haider, A., Shah, S. U., Sapna, F., Varrassi, G., Khatri, M., Kumar, S., & Mohamad, T. (2023). Exploring the Cardiovascular Benefits of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors: Expanding Horizons Beyond Diabetes Management. Cureus, 15(9), e46243. https://doi.org/10.7759/cureus.46243
Evidence review A for SGLT2 inhibitors for people with chronic kidney disease and type 2 diabetes: Type 2 diabetes in adults: management: Evidence review A. London: National Institute for Health and Care Excellence (NICE); 2021 Nov 24. (NICE Guideline, No. 28.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK591834/
Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., Lingvay, I., Rosenstock, J., Seufert, J., Warren, M. L., Woo, V., Hansen, O., Holst, A. G., Pettersson, J., Vilsbøll, T., & SUSTAIN-6 Investigators (2016). Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. The New England journal of medicine, 375(19), 1834–1844. https://doi.org/10.1056/NEJMoa1607141
Horwich, T. B., Fonarow, G. C., & Clark, A. L. (2018). Obesity and the Obesity Paradox in Heart Failure. Progress in cardiovascular diseases, 61(2), 151–156. https://doi.org/10.1016/j.pcad.2018.05.005
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