This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: April 17, 2007, Volume 115, Number 15 All Versions of this Article: 115/15/1991    most recent CIRCULATIONAHA.106.625400v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Scholze, J. Articles by Kintscher, U. Search for Related Content PubMed PubMed Citation Articles by Scholze, J. Articles by Kintscher, U. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Blood Pressure Medicines High Blood Pressure Obesity Hazardous Substances DB CYCLOBUTANE HYDROCHLOROTHIAZIDE METOPROLOL VERAPAMIL HYDROCHLORIDE Related Collections Obesity Glucose intolerance Clinical Studies Related Article

(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.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2007 115: 1969. [Extract] [Full Text]

This article has been cited by other articles:

				E. Idelevich, W. Kirch, and C. Schindler Current pharmacotherapeutic concepts for the treatment of obesity in adults Therapeutic Advances in Cardiovascular Disease, February 1, 2009; 3(1): 75 - 90. [Abstract] [PDF]

				F. H. Messerli, S. Bangalore, and S. Julius Risk/Benefit Assessment of {beta}-Blockers and Diuretics Precludes Their Use for First-Line Therapy in Hypertension Circulation, May 20, 2008; 117(20): 2706 - 2715. [Full Text] [PDF]

				B. Williams The Year in Hypertension J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1803 - 1817. [Full Text] [PDF]

				I. Biaggioni Should We Target the Sympathetic Nervous System in the Treatment of Obesity-Associated Hypertension? Hypertension, February 1, 2008; 51(2): 168 - 171. [Full Text] [PDF]

				S. von Haehling, M. Lainscak, and S. D. Anker Sibutramine in cardiovascular disease: is SCOUT the new STORM on the horizon? Eur. Heart J., December 1, 2007; 28(23): 2830 - 2831. [Full Text] [PDF]

				B. Williams The Obese Hypertensive: The Weight of Evidence Against {beta}-Blockers Circulation, April 17, 2007; 115(15): 1973 - 1974. [Full Text] [PDF]