Management of hypertension in obese patients requires a multifaceted approach including lifestyle modifications and individualized multidrug pharmacological therapy, often prioritizing ACE inhibitors or ARBs.
May support multidrug regimens favoring ACE inhibitors or ARBs in obese hypertension; leaves open need for dedicated RCTs.
Obesity is currently a true global pandemic associated with multiple co-morbidities, particularly cardiovascular, renal and metabolic diseases. There is a well-known link between obesity and hypertension, many cases of hypertension can be attributed to obesity. Reducing body weight and physical activity are important for controlling blood pressure. Currently, there are no specific guidelines about treating hypertension associated with obesity. The treatment is based on clinical experience of each physician, the knowledge of exact mechanisms of hypertension associated with obesity, comorbidities, side effects, economic reasons (cost of drugs), frequency of dosing. The majority of anti-hypertensive treatment schemes include a diuretic, an inhibitor of the renin-angiotensin system and/or a calcium channel blocker. If necessary, a mineralocorticoid receptor antagonist may be added. In patients with stage 2 hypertension a combination of two antihypertensive agents with complementary mechanisms of action is preferred. Most obese hypertensive patients need multiple antihypertensive drugs, because the prevalence of resistant hypertension is high in this population.
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Camelia Cristina Diaconu (2016) studied this question.
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