Blood pressure and cardiorenal responses to antihypertensive therapy in obese women.
OBJECTIVE
Blood pressure (BP) and target organ responses to antihypertensive drugs are not well established in hypertensive obese patients. This study is aimed at evaluating the effects of obesity and adiposity distribution patterns on these responses.


METHODS
49 hypertensive obese women were designated to different groups according to waist to hip ratio measurements--37 with troncular and 12 with peripheral obesity. Patients were treated for 24-weeks on a stepwise regimen with cilazapril alone or a cilazapril/hydrochlorothiazide/amlodipine combination therapy to achieve a BP lower than 140/90 mmHg. Ambulatory blood pressure monitoring (ABPM), echocardiography, and albuminuria were assessed before and after the intervention.


RESULTS
After 24 weeks, weight loss was less than 2% in both groups. ABPM targets were achieved in 81.5% of patients upon a combination of 2(26.5%) or 3(55.1%) drugs. Similar reductions in daytime-SBP/DBP: -22.5/-14.1(troncular obesity)/-23.6/-14.9 mmHg (peripheral obesity) were obtained. Decrease in nocturnal-SBP was greater in troncular obesity patients. Upon BP control, microalbuminuria was markedly decreased, while only slight decrease in left ventricular mass was observed for both groups.


CONCLUSIONS
In the absence of weight loss, most patients required combined antihypertensive therapy to control their BP, regardless of their body fat distribution pattern. Optimal target BP and normal albuminuria were achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude.
Rosa
Eduardo Cantoni
EC
Hypertension and Cardiovascular Metabology Center, Kidney and Hypertension Hospital, Division of Nephrology, São Paulo Federal University, São Paulo, SP, Brazil. eduardocantoni@uol.com.br
Zanella
Maria Tereza
MT
Kohlmann
Nárcia Elisa Bellucci
NE
Ferreira
Sandra Roberta Gouveia
SR
Plavnik
Frida Liane
FL
Ribeiro
Artur Beltrame
AB
Kohlmann
Osvaldo
O
D000328:Adult; D017311:Amlodipine / Q000627:therapeutic use; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D050218:Body Fat Distribution; D015992:Body Mass Index; D017315:Cilazapril / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D017315:Cilazapril; D017311:Amlodipine