When blood pressure stays high even with treatment, it can be frustrating. This is called resistant hypertension. In many cases, body fat percentage can play a role and make blood pressure harder to manage.

The amount of adipose tissue, or fat tissue, you have can affect your heart health. Higher body fat, especially around the belly, is linked to an increased risk of cardiovascular (heart) disease.

Obesity can cause changes in the body, such as added strain on the heart and ongoing inflammation. These changes may lead to high blood pressure and cardiovascular disease. They may also make blood pressure treatments less effective.

Knowing the role body fat plays in resistant hypertension can help you and your doctor find the best ways to improve your heart and overall health.

In this article, we’ll discuss body fat percentage and how it can contribute to resistant hypertension.

Body Fat Percentage vs. Body Mass Index

Your body fat percentage is a measure of how much of your body weight is made up of fat compared to bone, muscle, and other tissues. Body mass index (BMI) is a tool commonly used to diagnose obesity.

BMI has several limits. It does not show how much of your weight comes from fat or muscle. According to The Nutrition Source from the Harvard T.H. Chan School of Public Health, BMI also does not account for differences in fat and muscle between men and women, how body fat can change with age, or where fat is stored in the body.

Because BMI isn’t always an accurate predictor of health, it’s often used together with body fat percentage to estimate your health risks. Knowing your body fat percentage can help you understand your risk of certain health conditions.

Your healthcare provider can use formulas to estimate whether your body fat percentage is higher than it should be. Your waist-to-height ratio can help show whether you’re carrying more fat around your waist, which may point to a higher risk of health issues. To find this ratio, your healthcare provider measures your waist and divides that number by your height.

Your waist-to-height ratio can help estimate your risk of cardiovascular disease and diabetes. In general, a larger waist compared with your height may point to a higher risk of these health problems.

There are also ways to estimate your body fat percentage. Skinfold calipers, for example, are a helpful tool for measuring fat located under the skin. Smart scales, often found at gyms and fitness studios, also measure fat percentage.

Body Fat Percentage and High Blood Pressure

Having a high percentage of body fat can be a risk factor for developing high blood pressure. This is especially true for treatment-resistant hypertension. This higher risk is linked to obesity-related changes, especially when fat is stored in certain areas.

How Higher Body Fat Can Affect Blood Pressure

The body has different types of fat tissue. Many types of fat aren’t harmful. In fact, they help the body work the way it should.

Most of the fat in our bodies is white fat. This type of fat is stored around areas like the hips, belly, and legs.

White fat releases substances that send messages through the body. These include hormones such as leptin and adiponectin.

Leptin helps control hunger and how the body uses energy. As body fat increases, leptin levels often rise.

Adiponectin helps the body respond to insulin, the hormone that controls blood sugar. As body fat increases, adiponectin levels often go down. When adiponectin is low compared with leptin, the body may have less protection against insulin resistance and low-grade inflammation, both of which are linked to diabetes and heart disease.

Insulin resistance can also affect blood vessels. Insulin helps blood vessels relax, but when the body becomes resistant to insulin, blood vessels may not relax as well. This can raise blood pressure.

Leptin can also activate the sympathetic nervous system, your body’s fight-or-flight system, which can raise blood pressure.

Obesity-related changes can affect the renin-angiotensin-aldosterone system (RAAS), a hormone system that helps control fluid levels and blood pressure. When RAAS is overactive, the kidneys may hold on to more salt and water, and blood vessels may tighten. This can lead to extra fluid in the body and high blood pressure.

Obesity can also cause ongoing inflammation. Over time, inflammation can damage blood vessels and contribute to plaque buildup in the arteries. This can raise blood pressure and increase the risk of cardiovascular disease.

On the other hand, a healthy diet and physical activity can help lower inflammation and blood pressure.

How Body Fat Distribution Influences High Blood Pressure

Where fat is stored in your body can also affect blood pressure. Fat tissue found just below the skin that can be pinched is called subcutaneous fat. This is the kind of fat that your body stores for energy.

Fat tissue that builds up deep within the abdomen is called visceral fat. Too much subcutaneous fat can increase disease risks, but high blood pressure is more closely tied to visceral fat.

Subcutaneous fat can build up around your hips, thighs, or buttocks. You may also have this type of fat near your waistline, but its location just below the skin separates it from deeper, visceral fat.

A very high amount of subcutaneous fat may raise your risk of health problems. This risk might be due to how large amounts of subcutaneous fat are often linked to higher amounts of visceral fat.

Visceral fat accumulates around organs like the liver, pancreas, and heart. This fat can increase the pressure inside the abdomen, which may make nearby organs work harder. When this happens near the kidneys, it can make their job harder.

The kidneys help control fluid levels and blood pressure. If they don’t work as well, the body may hold on to extra fluid, which can raise blood pressure.

Visceral fat is also linked to insulin resistance and inflammation, along with a greater risk of high blood pressure, cardiovascular disease, type 2 diabetes, and other health conditions.

Research suggests the waist-to-height ratio can help estimate the risk of high blood pressure. But no single body measurement works perfectly for everyone.

Higher Body Fat and Resistant Hypertension

Living with obesity raises your risk of heart disease as well as cardiovascular events, such as heart failure and stroke. Resistant hypertension is also linked to a higher risk of cardiovascular problems. Together, these conditions can make you more likely to have heart problems and make blood pressure harder to control.

Living with obesity can raise the chance of having other health conditions, which can also increase the risk of heart disease. Having more than one of these conditions can contribute to high blood pressure and make antihypertensive drugs work less well.

If blood pressure is hard to control, doctors may check whether it is truly resistant hypertension.

This can include making sure blood pressure is being measured correctly, checking that medicines are being taken as prescribed, and looking for other causes (like sleep apnea, kidney problems, or certain medications). Treatment may include lifestyle changes and adjusting or adding medicines to get blood pressure to a safer range.

Other health conditions that can affect blood pressure, heart health, and how well treatment works include:

• Obstructive sleep apnea (OSA) — Having extra weight around the neck can put pressure on the airways and increase your risk of this sleep disorder. Over time, OSA can cause structural changes to blood vessels and stiffen arteries, which can raise blood pressure and make it hard to control.
• Diabetes mellitus — Having diabetes is a risk factor for developing resistant hypertension. About 70 percent of people with obesity have insulin resistance, which can contribute to high blood pressure that’s hard to treat.
• Renal (kidney) problems — Having chronic kidney disease or other issues with kidney function makes you more likely to develop treatment-resistant hypertension. Having high blood pressure and diabetes can also cause damage to blood vessels in the kidneys, which can further complicate treatment.
• Metabolic syndrome — High blood pressure, too much visceral fat, elevated blood sugar, and high cholesterol or triglyceride levels can be signs of metabolic syndrome. This condition increases your risk of developing cardiovascular disease, diabetes, and stroke.

The link between body fat and hard-to-treat high blood pressure is complex. Other health conditions can also play a role.

If you’re living with obesity and high blood pressure, talk with your healthcare provider about ways to manage your blood pressure. They may suggest healthy eating, regular physical activity, or other steps that can help with weight loss.

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