Renal and cardiovascular considerations for the nonpharmacological and pharmacological therapies of obesity-hypertension.
Obesity-associated hypertension is a common disease that involves a complex pathogenesis. Failure to control hypertension (HTN) in obese subjects provides a great threat to their renal and cardiovascular functions. The treatment of obesity-associated HTN is often difficult, and requires nonpharmacological and/or pharmacological approaches. Weight reduction is the cornerstone of the therapies of obesity-HTN, as it reverses the multiple components of its pathogenesis. When weight loss cannot be sustained or fails, pharmacological means should then be used. Angiotensin-converting enzyme inhibitors (ACEI) are the drug of choice: they can reduce blood pressure, protect the kidney and heart, and improve the metabolic abnormalities in obese subjects. Angiotensin-2 type-1 receptor blockers have a renoprotective benefit similar to ACEI, and they provide an important alternative to the use of ACEI. Diuretics are very effective in African-American obese hypertensives, but small doses should be used to avoid adverse effects on metabolic profiles. Long-acting calcium channel blockers are also effective and have the advantage of no adverse metabolic effects. Nondihydropyridine calcium channel blockers may provide additional renal and cardiovascular protective effects. The beta-adrenergic receptor blockers can cause further weight gain and metabolic abnormalities in obese subjects; therefore, careful monitoring is needed. There are few clinical data that support the efficacy and benefit of centrally acting alpha-2 agonists and alpha-adrenergic receptor antagonists in the treatment of obesity-HTN.
Zhang
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R
Louisiana State University Health Science Center, New Orleans, LA 70112-2822, USA.
Thakur
V
V
Morse
S
S
Reisin
E
E
D002320:Cardiovascular Physiological Phenomena; D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D007668:Kidney / Q000502:physiology*; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss / Q000502:physiology