Document Detail

Long-term effects of weight-reducing drugs in hypertensive patients.
MedLine Citation:
PMID:  19588440     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: All major guidelines for antihypertensive therapy recommend weight loss; anti-obesity drugs might be a helpful option.
PRIMARY OBJECTIVES: To assess the long-term effects of pharmacologically induced reduction in body weight with orlistat, sibutramine or rimonabant on:- all cause mortality - cardiovascular morbidity - adverse events
SECONDARY OBJECTIVES: - changes in systolic and/or diastolic blood pressure - body weight reduction
SEARCH STRATEGY: Studies were obtained from computerised searches of Ovid MEDLINE, EMBASE, CENTRAL and from hand searches in reference lists and systematic reviews.
SELECTION CRITERIA: Randomized controlled trials in adult hypertensive patients with a study duration of at least 24 weeks comparing pharmacologic interventions (orlistat, sibutramine, rimonabant) for weight loss with placebo.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed risk of bias and extracted data. Studies were pooled using fixed-effect meta-analysis in the absence of significant heterogeneity between studies (p>0.1). Otherwise, we used the random effects method and investigated the cause of heterogeneity.
MAIN RESULTS: Eight studies comparing orlistat or sibutramine to placebo fulfilled our inclusion criteria. No relevant studies investigating rimonabant for weight loss were identified. No study included mortality and cardiovascular morbidity as a pre-defined outcome. Incidence of gastrointestinal side effects was consistently higher in orlistat treated vs. placebo treated patients. Most frequent side effects with sibutramine were dry mouth, constipation and headache. Patients assigned to weight loss diets, orlistat or sibutramine reduced their body weight more effectively than patients in the usual care/placebo groups. Blood pressure reduction in patients treated with orlistat was for systolic blood pressure (SBP): weighted mean difference (WMD): -2.5 mm Hg; 95% CI, -4.0 to -0.9 mm Hg and for diastolic blood pressure (DBP): WMD -1.9 mm Hg; 95% CI, -3.0 to -0.9 mm Hg. Meta-analysis showed DBP increase under therapy with sibutramine: WMD +3.2 mm Hg; 95%CI +1.4 to +4.9 mm Hg.
AUTHORS' CONCLUSIONS: In patients with elevated blood pressure, orlistat and sibutramine reduced body weight to a similar degree. In the same trials, orlistat reduced blood pressure and sibutramine increased blood pressure. No trials investigating rimonabant in people with elevated blood pressure could be included. Long-term trials assessing the effect of orlistat, sibutramine and rimonabant on mortality and morbidity are needed.
Andrea Siebenhofer; Karl Horvath; Klaus Jeitler; Andrea Berghold; Anne K Stich; Eva Matyas; Nicole Pignitter; Ulrich Siering
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2009-07-08
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2009  
Date Detail:
Created Date:  2009-07-09     Completed Date:  2009-08-14     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD007654     Citation Subset:  IM    
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MeSH Terms
Anti-Obesity Agents / adverse effects*
Blood Pressure / drug effects
Cyclobutanes / adverse effects*
Hypertension / drug therapy*,  mortality
Lactones / adverse effects*
Middle Aged
Piperidines / adverse effects
Pyrazoles / adverse effects
Randomized Controlled Trials as Topic
Weight Loss*
Reg. No./Substance:
0/Anti-Obesity Agents; 0/Cyclobutanes; 0/Lactones; 0/Piperidines; 0/Pyrazoles; 158681-13-1/rimonabant; 96829-58-2/orlistat; WV5EC51866/sibutramine
Update In:
Cochrane Database Syst Rev. 2013;3:CD007654   [PMID:  23543553 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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