Renal and cardiovascular considerations for the nonpharmacological and pharmacological therapies of obesity-hypertension.

Abstract

Obesity-associated hypertension is a common disease that involves a complex pathogenesis. Failure to control hypertension (HTN) in obese subjects provides a great threat to their renal and cardiovascular functions. The treatment of obesity-associated HTN is often difficult, and requires nonpharmacological and/or pharmacological approaches. Weight reduction is the cornerstone of the therapies of obesity-HTN, as it reverses the multiple components of its pathogenesis. When weight loss cannot be sustained or fails, pharmacological means should then be used. Angiotensin-converting enzyme inhibitors (ACEI) are the drug of choice: they can reduce blood pressure, protect the kidney and heart, and improve the metabolic abnormalities in obese subjects. Angiotensin-2 type-1 receptor blockers have a renoprotective benefit similar to ACEI, and they provide an important alternative to the use of ACEI. Diuretics are very effective in African-American obese hypertensives, but small doses should be used to avoid adverse effects on metabolic profiles. Long-acting calcium channel blockers are also effective and have the advantage of no adverse metabolic effects. Nondihydropyridine calcium channel blockers may provide additional renal and cardiovascular protective effects. The beta-adrenergic receptor blockers can cause further weight gain and metabolic abnormalities in obese subjects; therefore, careful monitoring is needed. There are few clinical data that support the efficacy and benefit of centrally acting alpha-2 agonists and alpha-adrenergic receptor antagonists in the treatment of obesity-HTN.

• Authors: R Zhang, V Thakur, S Morse, E Reisin
• Journal: Journal of human hypertension (J Hum Hypertens) Vol. 16 Issue 12 Pg. 819-27 (Dec 2002) ISSN: 0950-9240 [Print] England
• PMID: 12522462 (Publication Type: Journal Article, Review)

Topics

• Cardiovascular Physiological Phenomena
• Clinical Trials as Topic
• Humans
• Hypertension (epidemiology, physiopathology, therapy)
• Kidney (physiology)
• Obesity (epidemiology, physiopathology, therapy)
• Risk Factors
• Treatment Outcome
• United States (epidemiology)
• Weight Loss (physiology)