Management of hypertension in overweight and obese patients: A practical guide for clinicians |
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Authors: | Francesco Dentali MD Arya M Sharma MD FRCP James D Douketis tMD FRCP |
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Institution: | (1) St. Joseph’s Hospital, Room F-541, 50 Charlton Avenue East, L8N 4A6 Hamilton, Ontario, Canada |
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Abstract: | The association between obesity and cardiovascular disease is well established, and up to 60% of overweight or obese patients
have hypertension. Dietary interventions associated with modest weight loss are effective in controlling blood pressure and
in reducing use of antihypertensive drug therapy in overweight and obese patients. However, long-term maintenance of weight
loss is achieved only in a small proportion of patients. Orlistat and sibutramine may help to achieve and maintain weight
loss but may not be sufficient to control blood pressure in overweight and obese hypertensive patients. Consequently, antihypertensive
drug therapy is often necessary in addition to weight loss interventions. Few studies have investigated different antihypertensive
drugs, specifically in overweight and obese patients with hypertension. Based on studies involving obese and nonobese patients,
first-line treatment options include a diuretic alone or an angiotensin-converting enzyme (ACE) inhibitor alone. If monotherapy
is inadequate for blood pressure control, combination therapy with diuretic and ACE inhibitor and/or combining either of these
drugs with a calcium channel blocker are reasonable treatment options. Additional studies to further clarify the management
of these patients are warranted. |
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