Optimizing blood pressure control in the obese patient.

Obesity is a major public health issue, and hypertension is one of the most common associated comorbidities. Current guidelines for optimal blood pressure levels in obese patients or for the treatment of obesity-hypertension do not provide specific recommendations that go beyond the rather general recommendation to lose weight. Based on the strong ties between obesity, hypertension, and type 2 diabetes, and the similarity of complications that occur in obesity-related hypertension and in hypertension associated with type 2 diabetes, it seems appropriate to explore the optimal blood pressure levels for obese hypertensive patients. Recently published studies underline the importance of weight reduction to reach this goal. Several lines of reasoning support the use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers as the appropriate first-line therapy in obese patients with uncomplicated hypertension. Nondihydropyridine calcium channel blockers, a-blockers, or low-dose diuretics may be added when necessary. Clearly, further studies are needed to define target blood pressure levels in obese patients and to clarify the value of established and newer drugs, like angiotensin receptor blockers, for the treatment of obese hypertensive patients. The role of antiobesity drugs in the management of the obese hypertensive patient also remains to be defined.