Choice of drug treatment for obesity-related hypertension: where is the evidence?

Hypertension and obesity are common medical conditions independently associ ated with increased cardiovascular risk. Many large epidemiological studies have demonstrated associations between body mass index and blood pressure, and there is evidence to suggest that obesity is a causal factor in the de velopment of hypertension in obese individuals, Consequently, all hypertens ion management guidelines consider weight reduction as a first step in the management of increased blood pressure in obese individuals. Weight reducti on may be achieved by behaviour modification, diet and exercise, or by the use of anti-obesity medications. However, the long-term outcomes of weight management programmes for obesity are generally poor, and most hypertensive patients will require antihypertensive drug treatment. Some classes of ant ihypertensive agents may have potentially unwanted effects on some of the m etabolic and haemodynamic abnormalities that link obesity and hypertension, yet most hypertension guidelines fail to provide specific advice on the ph armacological management of obese patients. This may be because there are c urrently no studies examining the efficacy of specific antihypertensive age nts in reducing mortality in obese hypertensive patients. This paper review s the theoretical reasons for the differential use of the major classes of antihypertensive agents in the pharmacological management of obesity-relate d hypertension and also considers the potential role of anti-obesity agents . (C) 2001 Lippincott Williams & Wilkins.