The Pharmaceutical Journal
Vol 268 No 7186 p233-237
23 February 2002

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Obese patients not served by guidance

Guidelines for the treatment of hypertension fail to provide specific advice on its management in obese patients, said Professor Arya Sharma, Humboldt University of Berlin.

Professor Sharma, speaking at a meeting organised by the Association for the Study of Obesity this week, said that guidelines identified obesity as a risk factor adversely influencing the prognosis of hypertension and considered weight reduction to be the first stage in management. However, recommendations had not been made for the use of specific drugs in obese patients, probably because there were no published studies addressing the efficacy of antihypertensive agents in reducing mortality in such patients.

Subsequent analysis of trials conducted to date showed that in obese individuals, high dose thiazides and lisinopril seem to be equally efficacious. Beta-blockers are more efficacious than isradipine and seem to produce a greater reduction in blood pressure in obese people than in lean people, but are not without metabolic risk and could induce further weight gain. Diuretics are associated with both metabolic risk and neuroendocrine activation, while angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists have not been linked with weight gain, metabolic risk or neuroendocrine activation.

Thus, in Professor Sharma's opinion, antihypertensive agents affecting the renin-angiotensin system should be used as first-line in the management of obese hypertensive patients. Low dose thiazides or non-dihydropyridine calcium channel blockers are second choice, followed by calcium channel blockers of the dihydropyridine type. However, beta-blockers should be used with caution in these patients, he said.
— Contributed.