Obesity and Hypertension: The Dangerous Cardiovascular Link We Can No Longer Ignore

Dr. Kamal Kishor, Interventional Cardiologist, HOD, Dept. of Cardiology, Rama Heart Centre, Karnal, Haryana, India

Visceral obesity is a key driver of hypertension, acting as an early trigger in the cardiovascular–kidney–metabolic disease continuum.

The global rise in obesity has quietly fuelled another epidemic, hypertension. Excess body weight now accounts for nearly one-third of new hypertension cases worldwide, making obesity one of the most powerful and modifiable drivers of high blood pressure. Much of the increased risk of heart disease and stroke associated with a higher body mass index (BMI) is not direct, but mediated through hypertension, placing blood pressure control at the centre of cardiovascular prevention.

Long-term studies consistently show that weight gain and obesity significantly raise the likelihood of developing hypertension over time. Recognising this, experts now describe excess or dysfunctional adipose tissue as the earliest stage of the cardiovascular–kidney–metabolic continuum—a silent starting point that can progress to kidney disease, metabolic dysfunction, and ultimately overt cardiovascular disease if left unaddressed.

The mechanisms behind obesity-related hypertension are complex and interconnected. Insulin resistance, overactivation of the sympathetic nervous system and the renin–angiotensin system, increased aldosterone production from fat tissue, and physical pressure on the kidneys from visceral fat all play a role. Conditions such as obstructive sleep apnoea and chronic kidney disease further amplify this risk.

Importantly, it is not the overall weight alone that matters. Visceral fat, often reflected by waist circumference, emerges as a stronger predictor of hypertension than BMI itself. This insight reinforces the need to look beyond the scale and focus on targeted strategies that reduce central obesity to curb the growing burden of hypertension and cardiovascular disease.

(Source: Gallagher BD. Obesity, visceral adiposity, and the future of hypertension treatment. American Journal of Hypertension. 2026 Jan;39(1):15-7. )