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Current Hypertension Reports
Published in: Current Hypertension Reports 6/2015

01-06-2015 | Hypertension and Obesity (E Reisin, Section Editor)

Anti-hypertensive Drug Treatment of Patients with and the Metabolic Syndrome and Obesity: a Review of Evidence, Meta-Analysis, Post hoc and Guidelines Publications

Authors: Jonathan G. Owen, Efrain Reisin

Published in: Current Hypertension Reports | Issue 6/2015

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Abstract

Epidemiological studies have shown an increasing prevalence of obesity and the metabolic syndrome worldwide. Lifestyle modifications that include dietary changes, weight reduction, and exercise are the cornerstones in the treatment of this pathology. However, adherence to this approach often meets with failure in clinical practice; therefore, drug therapy should not be delayed. The ideal pharmacological antihypertensive regimen should target the underlying mechanisms involved in this syndrome, including sympathetic activation, increased renal tubular sodium reabsorption, and overexpression of the renin-angiotensin-aldosterone system by the adipocyte. Few prospective trials have been conducted in the search of the ideal antihypertensive regimen in patients with obesity and the metabolic syndrome. We summarize previously published ad hoc studies, prospective studies, and guideline publications regarding the treatment of hypertension in patients with obesity and the metabolic syndrome. We conclude that the optimal antihypertensive drug therapy in these patients has not been defined. Though caution exists regarding the use of thiazide diuretics due to potential metabolic derangements, there is insufficient data to show worsened cardiovascular or renal outcomes in patients treated with these drugs. In regard to beta blockers, the risk of accelerating conversion to diabetes and worsening of inflammatory mediators described in patients treated with traditional beta blockers appears much less pronounced or absent when using the vasodilating beta blockers. Renin-angiotensin-aldosterone system (RAAS) inhibition with an ACE or an ARB and treatment with calcium channel blockers appears safe and well tolerated in obesity-related hypertension and in patients with metabolic syndrome. Future prospective pharmacological studies in this population are needed.
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Metadata
Title
Anti-hypertensive Drug Treatment of Patients with and the Metabolic Syndrome and Obesity: a Review of Evidence, Meta-Analysis, Post hoc and Guidelines Publications
Authors
Jonathan G. Owen
Efrain Reisin
Publication date
01-06-2015
Publisher
Springer US
Published in
Current Hypertension Reports / Issue 6/2015
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-015-0558-9

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The Kidney in Obesity

Pulmonary Hypertension (JR Klinger, Section Editor)

Biomarkers and Prognostic Indicators in Pulmonary Arterial Hypertension

Novel Treatments for Hypertension (T Unger, Section Editor)

Blood Pressure Control versus Atrial Fibrillation Management in Stroke Prevention

Prevention of Hypertension: Public Health Challenges (P Muntner, Section Editor)

Dietary Sodium and Cardiovascular Disease

Therapeutic Trials (M Weir, Section Editor)

Are SGLT2 Inhibitors Reasonable Antihypertensive Drugs and Renoprotective?

Hypertension and the Kidney (RM Carey, Section Editor)

Activation of Mineralocorticoid Receptor in Salt-Sensitive Hypertension
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