Blood pressure and cardiorenal responses to antihypertensive therapy in obese women

Abstract

Objective: Blood pressure(BP) and target organ responses to antihypertensive drugs are not well established in hypertensive obese patients. This study is aimed at evaluating the effects of obesity and adiposity distribution patterns on these responses. Methods: 49 hypertensive obese women were designated to different groups according to waist to hip ratio measurements -37 with troncular and 12 with peripheral obesity. Patients were treated for 24-weeks on a stepwise regimen with cilazapril alone or a cilazapril/hydrochlorothiazide/amlodipine combination therapy to achieve a BP lower than 140/90mmHg. Ambulatory blood pressure monitoring (ABPM), echocardiography, and albuminuria were assessed before and after the intervention. Results: After 24 weeks, weight loss was less than 2% in both groups. ABPM targets were achieved in 81.5% of patients upon a combination of 2(26.5%) or 3(55.1%) drugs. Similar reductions in daytime-SBP/DBP: -22.5/-14.1(troncular obesity) / -23.6/-14.9mmHg (peripheral obesity) were obtained. Decrease in nocturnal-SBP was greater in troncular obesity patients. Upon BP control, microalbuminuria was markedly decreased, while only slight decrease in left ventricular mass was observed for both groups. Conclusions: In the absence of weight loss, most patients required combined antihypertensive therapy to control their BP, regardless of their body fat distribution pattern. Optimal target BP and normal albuminuria were achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude. RESUMORespostas Pressórica e Cardiorrenal à Terapia Anti-hipertensiva em Mulheres Obesas. As respostas pressórica e de órgãos-alvo mediante o tratamento anti-hipertensivo medicamentoso, não estão bem estabelecidas em pacientes obesos hipertensos. O presente estudo tem por objetivo avaliar as repercussões da obesidade e da distribuição de gordura corporal sobre estas respostas. Métodos: Foram avaliadas 49 mulheres obesas hipertensas, separadas em subgrupos com distribuição troncular (n = 37) e periférica (n = 12) de gordura, de acordo com a distribuição cintura/quadril. As pacientes foram tratadas por 24 semanas com um regime anti-hipertensivo escalonado, iniciando-se com cilazapril e adicionando-se na seqüência, hidroclortiazida e amlodipina, com alvo pressórico inferior a 140 x 90 mmHg. Foram realizados MAPA, ecocardiograma e microalbuminuria antes e após o tratamento. Resultados: Depois de 24 semanas observou-se perda de peso inferior a 2% em ambos os subgrupos. O controle pressórico à MAPA pode ser observado em 81,5% das pacientes mediante a combinação de duas (26,5%) ou três (55,1%) Previous research from our group has previously demonstrated the influence of obesity, and specifically visceral obesity, on the prevalence of hypertension, cardiovascular risk factors and target organ damage (3,9). Moreover, clinical data obtained from our outpatients showed the benefits of specific antihypertensive drugs and the independent influence of weight ...

Office and Ambulatory Blood Pressure-Lowering Effects of Combination Valsartan/Hydrochlorothiazide vs Hydrochlorothiazide-Based Therapy in Obese, Hypertensive Patients

“…Based on the analyses reported here, both study regimens were effective in reducing office and ABP, with significantly greater SBP reduction with valsartan/HCTZ vs amlodipine/HCTZ (at week 16) based on ABPM. Although other studies have confirmed the BP‐lowering effects of combination thiazide diuretics with ARBs other than valsartan, angiotensin‐converting enzyme inhibitors (ACEIs), direct renin inhibitors, or β‐blockers in obese, hypertensive patients, 19–23 none have compared combining ARBs with HCTZ as an initial regimen vs addition of amlodipine, a metabolically neutral agent, with HCTZ in patients susceptible to the development of diabetes.…”

A review of cardiopulmonary research in Brazilian medical journals: clinical, surgical and epidemiological data

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