Effect of Metformin on Weight Gain During Antihypertensive Treatment With a  -Blocker in Chinese Patients

Zhang, Jianliang; Zheng, Xing; Zou, Da-jin; Jianli, Qiu; Zhao, Xianxian; Qin, Yong-wen

doi:10.1038/ajh.2009.93

Cited by 5 publications

(13 citation statements)

References 36 publications

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“…A total of 16 RCTs reported on the change in BMI ( n = 2113 on MTF, n = 2252 on placebo/control, mean baseline BMI 25.7−35 kg/m 2 , MTF dose 500–2550 mg/day, intervention duration 3 months to 5 years). The pooled analysis showed an MD in change in BMI of −0.56 (95% CI −0.74, −0.37) kg/m 2 ( I 2 = 78%), favouring MTF 46,48,52,53,56,58,61,66,68,69,73,76,79,82–84 (Figure 3). Prespecified subgroup analysis did not show a significant difference according to the presence or absence of concomitant LSM, as a co‐intervention (Figure 4).…”

Section: Resultsmentioning

confidence: 99%

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The impact of metformin on weight and metabolic parameters in patients with obesity: A systematic review and meta‐analysis of randomized controlled trials

Haber,

Zarzour,

Ghezzawi

et al. 2024

Diabetes Obesity Metabolism

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There are conflicting data on the weight‐reducing potential of metformin (MTF) in nondiabetic patients with obesity. The purpose of this systematic review and meta‐analysis was to evaluate the effect of MTF on weight and cardiometabolic parameters in adults with overweight/obesity with or without nonalcoholic fatty liver disease (NAFLD) (CRD42018085512). We included randomized controlled trials (RCTs) in adults without diabetes mellitus, with mean body mass index (BMI) ≥ 25 kg/m2, with or without NAFLD, comparing MTF to placebo/control, lifestyle modification (LSM) or a US Food and Drug Administration‐approved anti‐obesity drug, reporting on weight or metabolic parameters, and extending over at least 3 months. We conducted a systematic search in MEDLINE, EMBASE, PubMed and the Cochrane Library without time limitation (until March 2022). We screened and selected eligible articles, abstracted relevant data, and assessed the risk of bias. All steps were in duplicate and independently. We conducted a random‐effects model meta‐analysis using Review Manager version 5.3, with prespecified subgroup analyses in case of heterogeneity. We identified 2650 citations and included 49 trials (55 publications). Compared to placebo, MTF was associated with a significant reduction in BMI (mean difference [MD] −0.56 [−0.74, −0.37] kg/m2; p < 0.0001), at doses ranging from 500 to 2550 mg/day, and with a significant percentage change in BMI of −2.53% (−2.90, −2.17) at the dose 1700 mg/day. There was no interaction by baseline BMI, MTF dose or duration, nor presence or absence of NAFLD. There was no significant difference between MTF and LSM. Orlistat was more effective than MTF (at doses of 1000–1700 mg/day) in terms of weight loss, with an MD in BMI of −3.17 (−5.88; −0.47) kg/m2, favouring the former. Compared to placebo/control, MTF improved insulin parameters, while no effect was detected when compared to LSM. A few small trials showed heterogenous effects on liver parameters in patients with NAFLD treated with MTF compared to placebo/control. There was a large variability in the expression of outcome measures and RCTs were of low quality. In conclusion, MTF was associated with a modest weight reduction in obese nondiabetic patients. Further high‐quality and better powered studies are needed to examine the impact of MTF in patients with insulin resistance and NAFLD.

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Section: Resultsmentioning

confidence: 99%

“…We identified 27 RCTs that evaluated lipid parameters in patients receiving MTF compared to placebo/control 47,48,52,54,57,59,63–67,69–71,73–75,77,79–81,84,86,88,89,99 …”

Section: Resultsmentioning

confidence: 99%

The impact of metformin on weight and metabolic parameters in patients with obesity: A systematic review and meta‐analysis of randomized controlled trials

Haber,

Zarzour,

Ghezzawi

et al. 2024

Diabetes Obesity Metabolism

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“… 90 Combining atenolol with nitrendipine significantly increases body weight and fasting blood glucose level in overweight and obese hypertensive patients, which needs to be controlled with metformin. 91 A fixed dose combination of metoprolol extended release with amlodipine was as effective, and well tolerated as a combination of losartan and amlodipine in reducing both SBP and DBP. 92 However, combining carvedilol extended release with lisinopril was not superior to monotherapy with the either drug, except in high dose combinations, despite producing additional reduction in 24-hour mean DBP.…”

Section: Beta-blocker Combinationsmentioning

confidence: 90%

Current Status of Beta-blockers in Hypertension

Kar¹,

Kar²

2016

CSI: Cardiology Update 2015 (2 Volumes)

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The invention of beta (β)-blockers culminated in a new era in the treatment of cardiovascular diseases (CD), and changed the course of pharmacology research for years to come. Since the introduction of propranolol into clinical practice in 1964, β-blockers enjoyed a special place in the clinicians’ armamentarium against CDs, especially for patients with ischemic heart diseases, and are still one of the most extensively used therapeutic drugs in both cardiac and non-cardiac ailments. Current uses of β-blockers in CDs include ischemic heart diseases, hypertension, cardiac arrhythmias, and heart failure. Other substantial non-cardiac uses include glaucoma, migraine, situational anxiety, benign essential tremors, and cardiac symptoms of thyrotoxicosis. This review covers some of the evolutionary changes of clinical uses of β-blockers, the rationale for their use, some recent controversies surrounding their use for treatment of hypertension, and advantages of newer additions to the group.

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“…These findings show the efficancy of metformin for obesity and insulin resistance (metabolic syndrome) in obese adolescents. Further, metformin may prevent weight gain and improve blood glucose levels in hypertensive patients who received combination therapy of calcium antagonist (nitrendipine) and beta-blocker (atenolol) over 14 months follow-up [60]. However, it should be aware that the concurrent combination use of drugs blocking the renin angiotensin system (ACEI or ARB) and metformin cause more frequently metformin-associated lactic acidosis leading acute renal failure [61].…”

Section: Pharmacological Treatments For Meta-bolic Syndrome (Insulin mentioning

confidence: 97%

Pharmacological Treatments for Obesity-Related Hypertension

Masuo¹

2010

CHYR

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Obesity, hypertension and obesity-related hypertension are growing health problems. Hypertension is an important risk factor for cardiovascular disease (CVD), particularly in patients with obesity, diabetes, and metabolic disease. Obese subjects are frequently associated with hypertension, diabetes mellitus, metabolic disease, and end-organ damage (i.e. end-stage renal damage). An integrated cardiovascular risk management approach is being adopted: aggressive blood pressure (BP) control is important in patients with high CVD risk, and well-tolerated antihypertensive agents with protective benefits beyond BP lowering are advantageous. The identification and management of these CVD risk factors is an important part of the overall management of hypertensive patients. Because patients in these special populations such as subjects with obesity or metabolic syndrome are more predisposed to target organ damage, stringent targets for blood pressure control have been set in clinical guidelines, however clinical trial and real-life evidence suggest that these targets are difficult to achieve.The first line of treatment of obesity and metabolic syndrome associated with obesity are weight loss with a lifestyle modification such as low caloric diet and exercise (see the previous chapter) or gastric band/gastric bypass surgery or bariatric surgery. Recently, anti-obesity drugs (Orlistat, Sibutramine) have been developed, but the precise effects on blood pressure and neurohormonal parameters have not been fully clarified. In addition, leptin administration (pegylated recombinant leptin; PEG-OB) as theoretical treatment for obesity has been examined in overweight or obese human and in animal models. Central leptin gene therapy was also examined in animal models. However, the anti-obesity effects of leptin administration were controversial.Recently, many clinical and epidemiological studies have shown that angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) are highly efficacious, persistent, well-tolerated antihypertensive agents, with additional benefits in obesity-related hypertension, cardiovascular pathogenesis, end-organ damage, and in metabolic syndrome. For example, the Irbesartan/HCTZ combination therapy Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) trial has shown comparable antihypertensive efficacy and tolerability regardless of BMI or diabetes status. Another observation is emerging that Telmisartan, in addition to blocking the angiotensin II type 1 receptor, activates the peroxisome proliferator-activated receptor (PPAR)-gamma, a well-known target for treatment of the metabolic syndrome and diabetes. This clinical evidence perhaps argues against this, with the The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) showing no benefit for Telmisartan compared with Ramipril, in prevention of new diabetes development.Another antihypertensive drug class with favourable properties are the centrally acting Imidazolin, M...

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Effect of Metformin on Weight Gain During Antihypertensive Treatment With a -Blocker in Chinese Patients

Abstract: Combination therapy of nitrendipine and atenolol may significantly increase BW and fasting BG in overweight or obese patients with hypertension. Metformin may prevent BW gain and improve BG levels in hypertensive patients who received combination therapy of nitrendipine and atenolol.

Cited by 5 publications

References 36 publications

The impact of metformin on weight and metabolic parameters in patients with obesity: A systematic review and meta‐analysis of randomized controlled trials

The impact of metformin on weight and metabolic parameters in patients with obesity: A systematic review and meta‐analysis of randomized controlled trials

Current Status of Beta-blockers in Hypertension

Pharmacological Treatments for Obesity-Related Hypertension

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