Therapeutic Considerations in the Treatment of Obesity Hypertension

Marion R. Wofford, MD, MPH; Margaret Miller Davis, MD; Kimberly G. Harkins, MD; Deborah S. King, PharmD; Sharon B. Wyatt, PhD, RN, CS; Daniel W. Jones, MD

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Conclusion

In summary, overweight and obesity are chronic diseases of epidemic proportions affecting more than 50% of US adults. The recent publication of the NHLBI guidelines for obesity management demonstrates the commitment to continued efforts to control this public health problem. Population-based lifestyle interventions are critical to combat this chronic medical problem.

The association between increasing body weight and hypertension has been demonstrated repeatedly. Obesity is now recognized as an independent risk factor for CVD and is strongly associated with other risk factors, including hypertension. Excess body fat is the dominant factor predisposing to blood pressure elevation, with a continuum of effect throughout the entire distribution of body fat. Weight reduction remains the most successful element of hypertension prevention and treatment programs. Patients should be encouraged that even modest weight loss can lead to blood pressure reduction. Appropriate modification of lifestyle factors can directly influence blood pressure levels and CVD risk at both individual and population levels. Clinical trials are needed to determine the most effective antihypertensive drugs in the obese, hypertensive patient. Weight loss drugs can be effective but are modest in their ability to produce weight loss. Some agents may offer viable adjunctive pharmacotherapy for obesity and apparently are safe for hypertensive patients, but additional long-term studies are needed to support safety and efficacy. Reliance on antiobesity pharmacotherapeutics as a mainstay of obesity therapy is, however, premature.

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