Therapeutic Trials (B Pitt, Section Editor)

Current Hypertension Reports

, 16:418

First online:

Should Patients with Obesity and Hypertension be Treated Differently from Those Who Are Not Obese?

  • Michael J. BlochAffiliated withDepartment of Medicine, University of Nevada School of MedicineRenown Institute for Heart & Vascular Health, Renown Regional Medical Center Email author 
  • , Anthony J. VieraAffiliated withDepartment of Family Medicine, University of North Carolina School of MedicineHypertension Research Program, University of North Carolina

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Obesity and hypertension frequently coexist. Measuring blood pressure (BP) accurately in obese patients is challenging and may require strategies that are less accurate, such as forearm cuffing or use of wrist cuffs. Pathophysiologic mechanisms of hypertension may differ between obese and non-obese individuals, which may result in differing effects of common BP-lowering medications. However, to date, there is insufficient trial data to recommend a different approach to medication selection based on body mass index. Additionally, the goal BP is generally not different between obese and non-obese patients. Weight loss should be emphasized for obese patients with hypertension, and interventions in addition to diet and exercise may include weight loss medications and bariatric surgery. Recognition and treatment of obstructive sleep apnea is also important.


Hypertension Obesity Body mass Index Blood pressure measurement Ambulatory blood pressure monitoring Home blood pressure monitoring Obstructive sleep apnea Sympathetic nervous system Renin angiotensin system Adiposity Arm circumference Blood pressure cuff size Obesity paradox Weight loss Blood pressure goals ACCOMPLISH blood pressure study Polysomnogram