Weight Loss Medications in the Treatment of Obesity and Hypertension


Purpose of Review

Weight loss is strongly associated with improvement in blood pressure; however, the mechanism of weight loss can impact the magnitude and sustainability of blood pressure reduction.

Recent Findings

Five drugs—orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion—are currently approved for weight loss therapy in the USA. Naltrexone/bupropion results in an increase in in-office and ambulatory blood pressure compared to placebo. Other therapies are associated with modest lowering of blood pressure, and are generally well-tolerated; nonetheless, evidence is limited regarding their effect on blood pressure, particularly longitudinally, in individuals with hypertension.


Although weight loss medications can be an effective adjunct to lifestyle modifications in individuals with obesity, there is limited evidence regarding their benefit with regard to blood pressure. Future studies evaluating the effectiveness of weight loss medications should include careful assessment of their short- and long-term impact on blood pressure in individuals with hypertension.

This is a preview of subscription content, log in to check access.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016. JAMA. 2018;319:1723–5. https://doi.org/10.1001/jama.2018.3060.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    •• The GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. https://doi.org/10.1056/NEJMoa1614362. This study analyzed data from >68 million persons to assess trends in overweight/obesity between 1980 and 2015. Additionally, the investigators quantified the burden of disease related to BMI, according to age, sex, cause, and BMI in 195 countries.

    Article  Google Scholar 

  3. 3.

    Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic burden of obesity: a systematic literature review. Int J Environ Res Public Health. 2017;14:435. https://doi.org/10.3390/ijerph14040435.

    Article  PubMed Central  Google Scholar 

  4. 4.

    Wormser D, Kaptoge S, Di Angelantonio E, Wood AM, Pennells L, Thompson A, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377:1085–95. https://doi.org/10.1016/S0140-6736(11)60105-0.

    Article  PubMed  Google Scholar 

  5. 5.

    Franceschini N, Gouskova NA, Reiner AP, Bostom A, Howard BV, Pettinger M, et al. Adiposity patterns and the risk for ESRD in postmenopausal women. Clin J Am Soc Nephrol. 2015;10:241–50. https://doi.org/10.2215/CJN.02860314.

    Article  PubMed  Google Scholar 

  6. 6.

    Booth JN 3rd, Li J, Zhang L, Chen L, Muntner P, Egan B. Trends in prehypertension and hypertension risk factors in US adults: 1999-2012. Hypertension. 2017;70:275–84. https://doi.org/10.1161/HYPERTENSIONAHA.116.09004.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Saydah S, Bullard KM, Cheng Y, Ali MK, Gregg EW, Geiss L, et al. Trends in cardiovascular disease risk factors by obesity level in adults in the United States, NHANES 1999-2010. Obesity (Silver Spring). 2014;22:1888–95. https://doi.org/10.1002/oby.20761.

    CAS  Article  Google Scholar 

  8. 8.

    Cohen JB. Hypertension in obesity and the impact of weight loss. Curr Cardiol Rep. 2017;19:98. https://doi.org/10.1007/s11886-017-0912-4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Yi SS, Firestone MJ, Beasley JM. Independent associations of sodium intake with measures of body size and predictive body fatness. Obesity (Silver Spring). 2015;23:20–3. https://doi.org/10.1002/oby.20912.

    CAS  Article  Google Scholar 

  10. 10.

    Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. JAMA. 2018;320:2020–8. https://doi.org/10.1001/jama.2018.14854.

    Article  PubMed  Google Scholar 

  11. 11.

    Fonseca-Reyes S, de Alba-Garcia JG, Parra-Carrillo JZ, Paczka-Zapata JA. Effect of standard cuff on blood pressure readings in patients with obese arms. How frequent are arms of a ‘large circumference’? Blood Press Monit. 2003;8:101–6. https://doi.org/10.1097/01.mbp.0000085763.28312.03.

    Article  PubMed  Google Scholar 

  12. 12.

    Sironi AM, Gastaldelli A, Mari A, Ciociaro D, Positano V, Buzzigoli E, et al. Visceral fat in hypertension: influence on insulin resistance and beta-cell function. Hypertension. 2004;44:127–33. https://doi.org/10.1161/01.HYP.0000137982.10191.0a.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Cox AJ, West NP, Cripps AW. Obesity, inflammation, and the gut microbiota. Lancet Diabetes Endocrinol. 2015;3:207–15. https://doi.org/10.1016/S2213-8587(14)70134-2.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Furukawa S, Fujita T, Shimabukuro M, Iwaki M, Yamada Y, Nakajima Y, et al. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004;114:1752–61. https://doi.org/10.1172/JCI21625.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Buglioni A, Cannone V, Cataliotti A, Sangaralingham SJ, Heublein DM, Scott CG, et al. Circulating aldosterone and natriuretic peptides in the general community: relationship to cardiorenal and metabolic disease. Hypertension. 2015;65:45–53. https://doi.org/10.1161/HYPERTENSIONAHA.114.03936.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Gamboa A, Figueroa R, Paranjape SY, Farley G, Diedrich A, Biaggioni I. Autonomic blockade reverses endothelial dysfunction in obesity-associated hypertension. Hypertension. 2016;68:1004–10. https://doi.org/10.1161/HYPERTENSIONAHA.116.07681.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    • Huby AC, Antonova G, Groenendyk J, Gomez-Sanchez CE, Bollag WB, Filosa JA, et al. The adipocyte-derived hormone leptin is a direct regulator of aldosterone secretion, which promotes endothelial dysfunction and cardiac fibrosis. Circulation. 2015;132:2134–45. https://doi.org/10.1161/CIRCULATIONAHA.115.018226. This in vitro study demonstrated that leptin acts directly on adrenal glomerulus cells to stimulate aldosterone production and pro-fibrotic cardiac markers.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Lohmeier TE, Iliescu R. The sympathetic nervous system in obesity hypertension. Curr Hypertens Rep. 2013;15:409–16. https://doi.org/10.1007/s11906-013-0356-1.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Cassis LA, Police SB, Yiannikouris F, Thatcher SE. Local adipose tissue renin-angiotensin system. Curr Hypertens Rep. 2008;10:93–8.

    CAS  Article  Google Scholar 

  20. 20.

    Martins LC, Figueiredo VN, Quinaglia T, Boer-Martins L, Yugar-Toledo JC, Martin JF, et al. Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness. J Hum Hypertens. 2011;25:532–8. https://doi.org/10.1038/jhh.2010.95.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Armario P, Calhoun DA, Oliveras A, Blanch P, Vinyoles E, Banegas JR, et al. Prevalence and clinical characteristics of refractory hypertension. J Am Heart Assoc. 2017;6:e007365. https://doi.org/10.1161/JAHA.117.007365.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Brill MJ, Diepstraten J, van Rongen A, van Kralingen S, van den Anker JN, Knibbe CA. Impact of obesity on drug metabolism and elimination in adults and children. Clin Pharmacokinet. 2012;51:277–304. https://doi.org/10.2165/11599410-000000000-00000.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Hanley MJ, Abernethy DR, Greenblatt DJ. Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet. 2010;49:71–87. https://doi.org/10.2165/11318100-000000000-00000.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Hollenstein UM, Brunner M, Schmid R, Muller M. Soft tissue concentrations of ciprofloxacin in obese and lean subjects following weight-adjusted dosing. Int J Obes Relat Metab Disord. 2001;25:354–8. https://doi.org/10.1038/sj.ijo.0801555.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Zuckerman M, Greller HA, Babu KM. A review of the toxicologic implications of obesity. J Med Toxicol. 2015;11:342–54. https://doi.org/10.1007/s13181-015-0488-6.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Ahmed SB, Fisher ND, Stevanovic R, Hollenberg NK. Body mass index and angiotensin-dependent control of the renal circulation in healthy humans. Hypertension. 2005;46:1316–20. https://doi.org/10.1161/01.HYP.0000190819.07663.da.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Wofford MR, Anderson DC Jr, Brown CA, Jones DW, Miller ME, Hall JE. Antihypertensive effect of alpha- and beta-adrenergic blockade in obese and lean hypertensive subjects. Am J Hypertens. 2001;14:694–8.

    CAS  Article  Google Scholar 

  28. 28.

    Raij L, Egan BM, Zappe DH, Purkayastha D, Samuel R, Sowers JR. Office and ambulatory blood pressure-lowering effects of combination valsartan/hydrochlorothiazide vs. hydrochlorothiazide-based therapy in obese, hypertensive patients. J Clin Hypertens (Greenwich). 2011;13:731–8. https://doi.org/10.1111/j.1751-7176.2011.00499.x.

    CAS  Article  Google Scholar 

  29. 29.

    Schmieder RE, Philipp T, Guerediaga J, Gorostidi M, Bush C, Keefe DL. Aliskiren-based therapy lowers blood pressure more effectively than hydrochlorothiazide-based therapy in obese patients with hypertension: sub-analysis of a 52-week, randomized, double-blind trial. J Hypertens. 2009;27:1493–501. https://doi.org/10.1097/HJH.0b013e32832be593.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Cohen JB, Stephens-Shields AJ, Denburg MR, Anderson AH, Townsend RR, Reese PP. Obesity, renin-angiotensin system blockade and risk of adverse renal outcomes: a population-based cohort study. Am J Nephrol. 2016;43:431–40. https://doi.org/10.1159/000446862.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Engeli S, May M, Nussberger J, Danser AHJ, Dole WP, Prescott MF, et al. Systemic and tissue-specific effects of aliskiren on the RAAS and carbohydrate/lipid metabolism in obese patients with hypertension. J Am Soc Hypertens. 2017;11(8):488–97. https://doi.org/10.1016/j.jash.2017.06.002.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Dorresteijn JA, Schrover IM, Visseren FL, Scheffer PG, Oey PL, Danser AH, et al. Differential effects of renin-angiotensin-aldosterone system inhibition, sympathoinhibition and diuretic therapy on endothelial function and blood pressure in obesity-related hypertension: a double-blind, placebo-controlled cross-over trial. J Hypertens. 2013;31:393–403. https://doi.org/10.1097/HJH.0b013e32835b6c02.

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Laffin LJ, Majewski C, Liao C, Bakris GL. Relationship between obesity, hypertension, and aldosterone production in postmenopausal African American women: a pilot study. J Clin Hypertens (Greenwich). 2016;18:1216–21. https://doi.org/10.1111/jch.12857.

    CAS  Article  Google Scholar 

  34. 34.

    Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003;42:878–84. https://doi.org/10.1161/01.HYP.0000094221.86888.AE.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Aucott L, Rothnie H, McIntyre L, Thapa M, Waweru C, Gray D. Long-term weight loss from lifestyle intervention benefits blood pressure?: a systematic review. Hypertension. 2009;54:756–62. https://doi.org/10.1161/HYPERTENSIONAHA.109.135178.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Ikramuddin S, Korner J, Lee WJ, Thomas AJ, Connett JE, Bantle JP, et al. Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. JAMA. 2018;319:266–78. https://doi.org/10.1001/jama.2017.20813.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Schiavon CA, Bersch-Ferreira AC, Santucci EV, Oliveira JD, Torreglosa CR, Bueno PT, et al. Effects of bariatric surgery in obese patients with hypertension: the GATEWAY randomized trial (gastric bypass to treat obese patients with steady hypertension). Circulation. 2018;137:1132–42. https://doi.org/10.1161/CIRCULATIONAHA.117.032130.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149:275–87. https://doi.org/10.1001/jamasurg.2013.3654.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Jakobsen GS, Smastuen MC, Sandbu R, Nordstrand N, Hofso D, Lindberg M, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA. 2018;319:291–301. https://doi.org/10.1001/jama.2017.21055.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Seravalle G, Colombo M, Perego P, Giardini V, Volpe M, Dell’Oro R, et al. Long-term sympathoinhibitory effects of surgically induced weight loss in severe obese patients. Hypertension. 2014;64:431–7. https://doi.org/10.1161/HYPERTENSIONAHA.113.02988.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Engeli S, Bohnke J, Gorzelniak K, Janke J, Schling P, Bader M, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension. 2005;45:356–62. https://doi.org/10.1161/01.HYP.0000154361.47683.d3.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Chagnac A, Weinstein T, Herman M, Hirsh J, Gafter U, Ori Y. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol. 2003;14:1480–6.

    Article  Google Scholar 

  43. 43.

    Straznicky NE, Grima MT, Lambert EA, Eikelis N, Dawood T, Lambert GW, et al. Exercise augments weight loss induced improvement in renal function in obese metabolic syndrome individuals. J Hypertens. 2011;29:553–64. https://doi.org/10.1097/HJH.0b013e3283418875.

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Hirsch J, Leibel RL, Mackintosh R, Aguirre A. Heart rate variability as a measure of autonomic function during weight change in humans. Am J Phys. 1991;261:R1418–23.

    CAS  Google Scholar 

  45. 45.

    Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. 2014;2:CD008066. https://doi.org/10.1002/14651858.CD008066.pub3.

    Article  Google Scholar 

  46. 46.

    Lin JS, O’Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. Behavioral counseling to promote a healthy lifestyle for cardiovascular disease prevention in persons with cardiovascular risk factors: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;161:568–78.

    Article  Google Scholar 

  47. 47.

    Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54. https://doi.org/10.1056/NEJMoa1212914.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    •• Chirinos JA, Gurubhagavatula I, Teff K, Rader DJ, Wadden TA, Townsend R, et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med. 2014;370:2265–75. https://doi.org/10.1056/NEJMoa1306187. This RCT of patients with obesity and moderate to severe sleep apnea evaluated the effects of weight loss, CPAP, or both on several intermediate markers of cardiovascular risk.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev. 2017;4:CD004022. https://doi.org/10.1002/14651858.CD004022.pub4.

    Article  PubMed  Google Scholar 

  50. 50.

    Schwingshackl L, Chaimani A, Schwedhelm C, Toledo E, Punsch M, Hoffmann G, et al. Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: a systematic review and network meta-analysis. Crit Rev Food Sci Nutr. 2018:1–14. https://doi.org/10.1080/10408398.2018.1463967.

  51. 51.

    Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3–10. https://doi.org/10.1056/NEJM200101043440101.

    CAS  Article  PubMed  Google Scholar 

  52. 52.

    Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, et al. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med. 2010;170:126–35. https://doi.org/10.1001/archinternmed.2009.470.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, et al. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006;24:215–33. https://doi.org/10.1097/01.hjh.0000199800.72563.26.

    CAS  Article  PubMed  Google Scholar 

  54. 54.

    Minami J, Ishimitsu T, Matsuoka H. Effects of smoking cessation on blood pressure and heart rate variability in habitual smokers. Hypertension. 1999;33:586–90.

    CAS  Article  Google Scholar 

  55. 55.

    Semlitsch T, Jeitler K, Berghold A, Horvath K, Posch N, Poggenburg S, et al. Long-term effects of weight-reducing diets in people with hypertension. Cochrane Database Syst Rev. 2016;3:CD008274. https://doi.org/10.1002/14651858.CD008274.pub3.

    Article  PubMed  Google Scholar 

  56. 56.

    Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173:20–8. https://doi.org/10.1016/j.ijcard.2014.02.026.

    Article  PubMed  Google Scholar 

  57. 57.

    Zhou X, Yu J, Li L, Gloy VL, Nordmann A, Tiboni M, et al. Effects of bariatric surgery on mortality, cardiovascular events, and cancer outcomes in obese patients: systematic review and meta-analysis. Obes Surg. 2016;26:2590–601. https://doi.org/10.1007/s11695-016-2144-x.

    Article  PubMed  Google Scholar 

  58. 58.

    Bolignano D, Zoccali C. Effects of weight loss on renal function in obese CKD patients: a systematic review. Nephrol Dial Transplant. 2013;28(Suppl 4):iv82–98. https://doi.org/10.1093/ndt/gft302.

    Article  PubMed  Google Scholar 

  59. 59.

    Chang AR, Chen Y, Still C, Wood GC, Kirchner HL, Lewis M, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int. 2016;90:164–71. https://doi.org/10.1016/j.kint.2016.02.039.

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    •• Gadde KM, Martin CK, Berthoud H-R, Heymsfield SB. Obesity: pathophysiology and management. J Am Coll Cardiol. 2018;71:69–84. https://doi.org/10.1016/j.jacc.2017.11.011. This an in-depth recent review of the pathophysiology, pathways from adiposity-associated major risk factors to development of heart failure, and a comprehensive review of interventions for obesity.

    Article  PubMed  Google Scholar 

  61. 61.

    Gadde KM, Apolzan JW, Berthoud HR. Pharmacotherapy for patients with obesity. Clin Chem. 2018;64:118–29. https://doi.org/10.1373/clinchem.2017.272815.

    CAS  Article  PubMed  Google Scholar 

  62. 62.

    Gadde KM. Current pharmacotherapy for obesity: extrapolation of clinical trials data to practice. Expert Opin Pharmacother. 2014;15:809–22. https://doi.org/10.1517/14656566.2014.890590.

    CAS  Article  PubMed  Google Scholar 

  63. 63.

    Gadde KM, Raj YP. Pharmacotherapy of obesity: clinical trials to clinical practice. Curr Diab Rep. 2017;17:34. https://doi.org/10.1007/s11892-017-0859-2.

    Article  PubMed  Google Scholar 

  64. 64.

    Hampp C, Kang EM, Borders-Hemphill V. Use of prescription antiobesity drugs in the United States. Pharmacotherapy. 2013;33:1299–307. https://doi.org/10.1002/phar.1342.

    Article  PubMed  PubMed Central  Google Scholar 

  65. 65.

    Xia Y, Kelton CM, Guo JJ, Bian B, Heaton PC. Treatment of obesity: pharmacotherapy trends in the United States from 1999 to 2010. Obesity. 2015;23:1721–8. https://doi.org/10.1002/oby.21136.

    Article  PubMed  Google Scholar 

  66. 66.

    Thomas CE, Mauer EA, Shukla AP, Rathi S, Aronne LJ. Low adoption of weight loss medications: a comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s. Obesity. 2016;24:1955–61. https://doi.org/10.1002/oby.21533.

    Article  PubMed  Google Scholar 

  67. 67.

    Adipex-P (phentermine hydrochloride) tablets prescribing information. Horsham: Teva Pharmaceuticals. 2017.

  68. 68.

    Aronne LJ, Wadden TA, Peterson C, Winslow D, Odeh S, Gadde KM. Evaluation of phentermine and topiramate versus phentermine/topiramate extended-release in obese adults. Obesity. 2013;21:2163–71. https://doi.org/10.1002/oby.20584.

    CAS  Article  PubMed  Google Scholar 

  69. 69.

    LeBlanc ES, O’Connor E, Whitlock EP, Patnode CD, Kapka T. Effectiveness of primary care-relevant treatments for obesity in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:434–47. https://doi.org/10.7326/0003-4819-155-7-201110040-00006.

    Article  PubMed  Google Scholar 

  70. 70.

    Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311:74–86. https://doi.org/10.1001/jama.2013.281361.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  71. 71.

    Khera R, Murad MM, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424–34. https://doi.org/10.1001/jama.2016.7602.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Sahebkar A, Simental-Mendia LE, Kovanen PT, Pedone C, Simental-Mendia M, Cicero AFG. Effects of orlistat on blood pressure: a systematic review and meta-analysis of 27 randomized controlled clinical trials. J Am Soc Hypertens. 2018;12:80–96. https://doi.org/10.1016/j.jash.2017.12.002.

    CAS  Article  PubMed  Google Scholar 

  73. 73.

    • Food and Drug Administration. Endocrinologic and Metabolic Drugs Advisory Committee. https://wayback.archive-it.org/7993/20170403223906/https://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/default.htm. Accessed 10 Dec 2018. FDA briefing documents drugs approved for weight management since 2010 are available via this link.

  74. 74.

    Food and Drug Administration. Guidance for industry: developing products for weight management, draft guidance, revision 1. Center for Drug Evaluation and Research (CDER). Rockville: FDA; 2007. https://www.fda.gov/downloads/Drugs/Guidances/ucm071612.pdf. Accessed 10 Dec 2018

    Google Scholar 

  75. 75.

    Orexigen Therapeutics. Contrave (naltrexone SR/bupropion SR combination), NDA 200063. Advisory committee briefing document. Endocrinologic and Metabolic Drugs Advisory Committee Meeting; 2010 December 7. https://wayback.archive-it.org/7993/20170405220555/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM235671.pdf. Accessed 10 Dec 2018.

  76. 76.

    Nissen SE, Wolski KE, Prcela L, Wadden T, Buse JB, Bakris G, et al. Effect of naltrexone-bupropion on major adverse cardiovascular events in overweight and obese patients with cardiovascular risk factors: a randomized clinical trial. JAMA. 2016;315:990–1004. https://doi.org/10.1001/jama.2016.1558.

    CAS  Article  PubMed  Google Scholar 

  77. 77.

    • Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377:1341–52. https://doi.org/10.1016/S0140-6736(11)60205-5. This is the largest RCT of the most effective of the currently available weight loss drugs.

    CAS  Article  PubMed  Google Scholar 

  78. 78.

    Siebenhofer A, Jeitler K, Horvath K, Berghold A, Posch N, Meschik J, et al. Long-term effects of weight-reducing drugs in people with hypertension. Cochrane Database Syst Rev. 2016:CD007654. https://doi.org/10.1002/14651858.CD007654.pub4.

  79. 79.

    Bohula EA, Wiviott SD, McGuire DK, Inzucchi SE, Kuder J, Im K, et al. Cardiovascular safety of lorcaserin in overweight or obese patients. N Engl J Med. 2018;379:1107–17.

    CAS  Article  Google Scholar 

  80. 80.

    Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–22. https://doi.org/10.1056/NEJMoa1603827.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  81. 81.

    Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63:2985–3023. https://doi.org/10.1016/j.jacc.2013.11.004.

    Article  PubMed  Google Scholar 

  82. 82.

    Siu AL. Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163:778–86. https://doi.org/10.7326/M15-2223.

    Article  PubMed  Google Scholar 

  83. 83.

    Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378:1509–20. https://doi.org/10.1056/NEJMoa1712231.

    Article  PubMed  Google Scholar 

  84. 84.

    Staessen JA, Thijs L, Fagard R, O’brien ET, Clement D, De Leeuw PW, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. JAMA. 1999;282:539–46. https://doi.org/10.1001/jama.282.6.539.

    CAS  Article  PubMed  Google Scholar 

  85. 85.

    Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348:2407–15. https://doi.org/10.1056/NEJMoa022273.

    Article  PubMed  Google Scholar 

  86. 86.

    Shimbo D, Abdalla M, Falzon L, Townsend RR, Muntner P. Role of ambulatory and home blood pressure monitoring in clinical practice: a narrative review. Ann Intern Med. 2015;163:691–700. https://doi.org/10.7326/M15-1270.

    Article  PubMed  PubMed Central  Google Scholar 

  87. 87.

    Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet. 2007;370:1219–29. https://doi.org/10.1016/S0140-6736(07)61538-4.

    Article  PubMed  Google Scholar 

  88. 88.

    Salles GF, Reboldi G, Fagard RH, Cardoso CR, Pierdomenico SD, Verdecchia P, et al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: the ambulatory blood pressure collaboration in patients with hypertension (ABC-H) meta-analysis. Hypertension. 2016;67:693–700. https://doi.org/10.1161/HYPERTENSIONAHA.115.06981.

    CAS  Article  PubMed  Google Scholar 

  89. 89.

    Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107:1401–6.

    Article  Google Scholar 

  90. 90.

    Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324. https://doi.org/10.1161/HYP.0000000000000066.

    CAS  Article  PubMed  Google Scholar 

Download references


The authors thank Katelyn Daigle for editorial assistance in preparing the manuscript.

Author information



Corresponding author

Correspondence to Kishore M. Gadde.

Ethics declarations

Conflict of Interest

Dr. Cohen has no financial conflicts of interest to disclose. Dr. Gadde is an advisor to AstraZeneca with payments made to his employer, Pennington Biomedical Research Center; has received research support from AstraZeneca, BioKier, and National Institutes of Health (NIH); and has received speaking honoraria from the American Diabetes Association.

Human and Animal Rights and Informed Consent

This review article does not contain any studies with human subjects or animals performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cohen, J.B., Gadde, K.M. Weight Loss Medications in the Treatment of Obesity and Hypertension. Curr Hypertens Rep 21, 16 (2019). https://doi.org/10.1007/s11906-019-0915-1

Download citation


  • Obesity
  • Hypertension
  • Blood pressure
  • Weight loss
  • Weight loss medication
  • Weight loss pharmacotherapy