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Treatment of arterial hypertension in obese patients.
MedLine Citation:
PMID:  23374895     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Obesity is an increasingly observed pathologic entity in the industrialized world and causally linked to the development of hypertension. Consequently, not only the prevalence of obesity but also the prevalence of obesity hypertension is increasing worldwide. In the context of antihypertensive treatment, data from clinical trials indicate that all first-line antihypertensive drugs possess a similar efficacy in reducing systemic blood pressure and hypertension-related end-organ damage in obese hypertensive subjects. Nevertheless, some antihypertensive agents, such as β-blockers or thiazide diuretics, may have unwanted side effects on the metabolic and hemodynamic abnormalities that occur in both obesity and hypertension. However, current guidelines still do not include recommendations for state-of-the-art treatment of obese patients with hypertension. Hence, the aim of this article is to provide recommendations for the appropriate use of antihypertensive agents in obese patients mostly based on personal expertise and pathophysiologic assumptions. For instance, thiazide diuretics and β-blockers are reported to reduce insulin sensitivity and (at least transiently) increase triglyceride and low-density lipoprotein cholesterol levels, whereas calcium channel blockers are metabolically neutral and angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and renin inhibition may increase insulin sensitivity. The renin-angiotensin-aldosterone system in the adipose tissue has been implicated in the development of arterial hypertension and sodium retention plays a central role in the development of obesity-related hypertension. Therefore, treatment with a blocker of the renin-angiotensin-aldosterone-system and a thiazide diuretic should be considered as first-line antihypertensive drug therapy in obesity hypertension.
Authors:
Ulrich O Wenzel; Ralf Benndorf; Sascha Lange
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Seminars in nephrology     Volume:  33     ISSN:  1558-4488     ISO Abbreviation:  Semin. Nephrol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-02-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8110298     Medline TA:  Semin Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  66-74     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
III Medizinische Klinik, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany. Electronic address: wenzel@uke.de.
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