REN and obesity due to melanocortin 4 receptor deficiency: Increased intravascular volume, activation of the sympathetic and renin-angiotensin-aldosterone systems, abnormal production of myocardial growth factors from abdominal and cardiac adipose tissue, and metabolic changes that increase arterial stiffness and peripheral vascular resistances all play a role in the pathophysiological mechanisms proposed to explain the relationship between obesity and LVH [30,25].