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The Management of Hypertension in the Overweight and Obese Patient

Is Weight Reduction Sufficient?

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Abstract

The management of hypertension in the overweight and obese patient is a frequently encountered but under investigated clinical problem. The conventional management of such patients involves weight reduction with dietary therapy or a combined approach with dietary and anti-obesity drug therapy. However, long-term weight reduction, which is necessary to sustain blood pressure (BP) control, is not feasible in over 80% of patients.

Anti-obesity therapy with orlistat has inconsistent effects on BP and may benefit only patients who have uncontrolled or non-medicated hypertension. Anti-obesity therapy with sibutramine may be associated with a modest worsening of BP control. Consequently, antihypertensive drug therapy is often required to supplement a weight reduction programme, and also in patients with severe hypertension or hypertension-associated end-organ damage.

Treatment with a thiazide diuretic should be considered as first-line antihypertensive drug therapy in overweight and obese patients. ACE inhibitors or non-dihydropyridine calcium channel antagonists are reasonable alternatives where clinically indicated, or they can be used in combination with a thiazide diuretic if treatment with the diuretic alone is insufficient. If such treatment is inadequate for BP control, the addition or substitution of an α- or β-adrenoceptor antagonist may be considered, although the latter can be associated with weight gain. Concurrent disease is an important determinant of first-line and supplementary antihypertensive drug therapy.

Additional studies are needed to determine the long-term (>1 year) efficacy and safety of antihypertensive and anti-obesity management strategies in the overweight and obese hypertensive patient.

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. Dr Douketis is a recipient of a research scholarship from the Heart and Stroke Foundation of Canada and Dr Sharma is a Canada Research Chair for Cardiovascular Obesity Research and Management. Drs Douketis and Sharma have served as consultants and have received honoraria from manufacturers of anti-obesity drugs.

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  1. Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    James D. Douketis & Arya M. Sharma

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  1. James D. Douketis
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Correspondence to James D. Douketis.

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Douketis, J.D., Sharma, A.M. The Management of Hypertension in the Overweight and Obese Patient. Drugs 64, 795–803 (2004). https://doi.org/10.2165/00003495-200464080-00001

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