Cardiovascular risk in obese hypertensive patients taking various antihypertensive drugs.

OBJECTIVE: Obese patients often present with multiple co-morbid conditions, including hypertension, which are associated with an increased cardiovascular (CV) risk. We aimed to assess the risk factor profiles of primary-care patients with obesity and hypertension in order to estimate their fatal CV risk in total and according to use of various antihypertensive drugs.
METHODS: This was a post-hoc analysis of data from a recent observational study involving 72 479 hypertensive patients in 6989 general practices across Germany. Almost all patients (92.3%) were overweight or obese. The 10-year risk for fatal CV events was determined using the SCORE algorithm as published by the European Society of Cardiology.
RESULTS: Overall, 68% of patients had one or more diseases or conditions in addition to obesity and hypertension. The 10-year fatal CV risk was lowest in the youngest normal weight group (1.7%), and highest in the oldest obese group (26%). Men had a higher risk than women, and risk rose with increasing age. The risk factor profile appeared to differ between patients treated with various antihypertensive classes, e.g. angiotensin II type 1 receptor antagonists were associated with lower risk, diuretics with higher risk. There were moderate differences within drug classes.
CONCLUSIONS: According to this cross-sectional data, fatal CV risk is strongly increased in obese patients, especially in men and in older age groups. While there were strong associations between use of certain drugs and metabolic risk markers and overall fatal CV risk, the causality of these associations remains to be determined.