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(Circulation. 2007;115:1991-1998.)
© 2007 American Heart Association, Inc.

Hypertension

Optimal Treatment of Obesity-Related Hypertension

The Hypertension-Obesity-Sibutramine (HOS) Study

Jürgen Scholze, MD; Elmar Grimm, MD; Dana Herrmann, MD; Thomas Unger, MD; Ulrich Kintscher, MD

From the Department of Medicine (J.S., E.G., D.H.), Outpatient Clinic, and Center for Cardiovascular Research (J.S., T.U., U.K.), Institute of Pharmacology, CCM, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Correspondence to Prof Dr Jürgen Scholze, Department of Medicine, Outpatient Clinic, CCM, Charité-Universitätsmedizin Berlin, Luisenstraße 11–13, 10117 Berlin, Germany. E-mail juergen.scholze{at}charite.de

Received March 7, 2006; accepted January 26, 2007.

Background— Current guidelines for the treatment of hypertension do not provide specific recommendations for obese hypertensive patients. To identify an optimal treatment regimen for obese hypertensive patients, we studied the interactions between a drug-based weight loss approach by sibutramine and different antihypertensive drug regimens.

Methods and Results— This was a prospective, 16-week double-blind placebo-controlled randomized multicenter study in 171 obese hypertensive patients. After a 2-week run-in period, patients receiving 1 of the 3 antihypertensive combination therapies (felodipine 5 mg/ramipril 5 mg [n=57], verapamil 180 mg/trandolapril 2 mg [n=55], or metoprolol succinate 95 mg/hydrochlorothiazide 12.5 mg [metoprolol/hydrochlorothiazide; n=59]) were assigned randomly to sibutramine (15 mg) or placebo. Sibutramine treatment resulted in a significantly greater decrease in body weight, body mass index, and waist circumference and a significant increase in diastolic blood pressure during 24-hour blood pressure monitoring compared with placebo treatment. Sibutramine-induced weight loss and reduction of visceral obesity were markedly attenuated in the metoprolol/hydrochlorothiazide group compared with the other groups. Consistently, improvement in glucose tolerance and hypertriglyceridemia by sibutramine was abrogated in the cohort treated with metoprolol/hydrochlorothiazide compared with the other groups.

Conclusions— The present study demonstrates for the first time that an antihypertensive combination therapy regimen with angiotensin-converting enzyme inhibitors and calcium channel blockers is more advantageous than a ß-blocker/diuretic–based regimen in supporting the weight-reducing actions and concomitant metabolic changes induced by sibutramine in obese hypertensive patients. These data may help to develop future comprehensive treatment strategies and guidelines for this high-risk patient population.

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