It has been speculated that increased body volume caused by excessive body fat could lead to a higher peripheral vascular resistance and a series of dysfunction, such as adiponectin deficiency, hyperleptinemia, elevated renin-angiotensin-aldosterone system hormones and mineralocorticoid-stimulating factors.30, 31, 32 These dysfunctions may in turn activate the renin-angiotensin-aldosterone system and sympathetic nervous system, which lead to endothelial dysfunction, impaired pressure natriuresis and vascular hypertrophy, and eventually raise blood pressure. This evidence concerns the gene REN and hyperinsulinemic hypoglycemia, familial, 4.