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Abstract

Many authors have suggested that obesity or overweight is associated with resistance to certain classes of antihypertensive medications, and the pathophysiology of hypertension in obesity suggests there may be differences in response to medications by body mass index (BMI). We assessed the effect of BMI on systolic (SBP), diastolic (DBP), and pulse pressure (PP) changes, both short and long-term, with drugs representing 6 classes of antihypertensive medications. We also examined the effect of these drugs on weight change. 1292 men with untreated diastolic hypertension (DBP 95-109 mm Hg) were randomized to hydrochlorothiazide (HCTZ) 12.5-50 mg QD, atenolol 25-100 mg QD, captopril 12.5-50 mg BID, clonidine 0.1-0.3 mg BID, diltiazem SR 60-180 mg BID, prazosin 2-10 mg BID, and placebo. Drug doses were titrated to achieve a goal DBP <90 mm Hg during a 4-8 week medication titration phase and, if DBP was controlled (<90 mm Hg), success in DBP control was assessed after 1 year.

Mean baseline BP was 152/99 mm Hg and BMI was 29 kg/m2. BMI did not predict change in any BP parameter (SBP, DBP, or PP) during titration for any drug. Only the 1 year success with atenolol was effected by BMI: obese (BMI≥30) patients were 2.5 times more likely to have DBP successfully controlled compared with lean (BMI<27) patients (p=0.0136), although being a current smoker and living in the southeast US attenuated the poor response to atenolol in lean vs obese hypertensive patients (p=0.08). Only prazosin was associated with significant increases in weight: 1.7 lb increase during titration (p<0.001 vs all other drugs) and after 1 year of follow-up (p=0.017 vs 2.1 lb weight decrease with HCTZ and captopril).

Conclusion: For hypertensive men with similar levels of untreated BP, these data do not suggest any resistance to monotherapy with these 6 classes of antihypertensive medications based on presence or absence of obesity. Weight increased with prazosin and decreased with HCTZ and captopril. Grant/Reseach support: BMS, Mende, Pfizer, AstraZensca, Solvaay/Unimed

Consultant: BMS, Merck, Norvartis, Takoda, Pharmacia, AstraZeneca

obesity, antihypertensive drugs, clinical trials
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© American Journal of Hypertension, Ltd. 2001
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