Antihypertensive therapy in the obese hypertensive patient.

PURPOSE OF REVIEW: Obesity is becoming recognized as one of the most important risk factors for the development of hypertension. The purpose of the review is to examine the latest evidence linking hypertension to obesity, summarize the benefits of weight reduction and present results of recent clinical trials evaluating antihypertensive treatment in obese patients. RECENT
FINDINGS: Adipose tissue has been directly implicated in the pathogenesis of hypertension. Obesity has been associated with unequivocal changes in cardiovascular structure and function. In contrast to earlier studies, several recent trials included overweight and obese patients. Evidence of potential benefits of angiotensin blockade in the management of obesity hypertension is growing. Hypertension management in obese individuals is complicated by poorer response to treatment, and the increased need for multiple medications. It is important to consider obstructive sleep apnea in obese patients with resistant hypertension.
SUMMARY: Several new lines of evidence suggest that drugs blocking the renin-angiotensin system might be considered as first-line therapy of obesity-related hypertension. Recent progress in understanding the mechanisms of obesity and associated disease processes might lead to development of novel therapeutic strategies. Further research in this area holds great promise for prevention of obesity-related cardiovascular disease.