The role of adipose tissue in the regulation and dysregulation of blood pressure: a conceptual narrative review

Adipose tissue is a metabolically active tissue with its amount and functionality known to affect cardiometabolic status of individuals including blood pressure. The aim of this review is to summarize the interactions of adipose with skeletal muscle and liver in the regulation and dysregulation of blood pressure. Online searches of Google Scholar, PubMed, and Scopus were conducted. Increased metabolic demands from tissues such as adipose tissue, skeletal muscle and gut causes local vasodilation and simultaneous widespread sympathetic activation to prevent fall in cardiac output and divert blood away from metabolically less active tissue at the moment. Both local vasodilatation and the systemic vasoconstriction are triggered by the same local factors such as ATP, ADP and bradykinin with the vasoconstriction effects mediated through afferent reflexes. This can cause blood pressure to either rise or fall depending on the balance between the local vasodilatory and systemic vasoconstrictor effects essentially making local metabolic activity a central factor in determining systemic blood pressure. Increased metabolic activity of skeletal muscle is synonymous with increased physical activity whereas increased metabolic activity of the gut is synonymous with feeding. In both cases, there is increased adipose tissue metabolic activity for opposing reasons; lipolysis in the former and fat storage in the latter. Increased lean body mass inevitably happens in the context of increased physical activity and skeletal muscle mass and with reduction of both fat mass and adipose tissue afferent reflex, hence reduction in blood pressure. Obesity happens under exactly opposite context; decreased physical activity and an increase in both fat mass and adipose tissue afferent reflex and thus high blood pressure.