Scholze J et al. (2007) Optimal treatment of obesity-related hypertension: the hypertension-obesity-sibutramine (HOS) study. Circulation 115: 1991–1998

Hypertension is common in obese patients and its treatment should be considered when planning a pharmacologic weight-loss program. Now, Scholze and co-workers have studied the effects of sibutramine therapy on obese patients being treated for hypertension.

This prospective, double-blind trial included 171 obese or overweight patients (BMI 27–45 kg/m2) with essential hypertension (systolic blood pressure 140–160 mmHg; diastolic blood pressure 90–100 mmHg) who were on one of three antihypertensive regimens: felodipine–ramipril (5 mg/5 mg; n = 57), slow-release verapamil–trandolapril (180 mg/2 mg; n = 55), or metoprolol succinate–hydrochlorothiazide (95 mg/12.5 mg; n = 59). After a 2-week run-in period, patients were randomly allocated to 10 mg/day of sibutramine (n = 87) or placebo (n = 84), increased to 15 mg/day after 8 weeks.

In the 145 patients who completed the 16-week treatment, decreases in body weight, BMI, and waist circumference were greater in the sibutramine group than in the placebo group (P <0.0001 for all); however, weight loss was significantly attenuated in the metoprolol–hydrochlorothiazide cohort compared with those receiving one of the other two antihypertensive regimens. In comparison with placebo, sibutramine improved glucose tolerance (though this effect was also attenuated by metoprolol–hydrochlorothiazide treatment) and lowered triglyceride and fasting glucose levels. Changes in blood pressure from baseline did not differ significantly between the sibutramine and placebo groups or between the three antihypertensive cohorts.

Metoprolol–hydrochlorothiazide therapy attenuates both the weight-loss action of sibutramine and its beneficial effects on visceral obesity; therefore, felodipine–ramipril or slow-release verapamil–trandolapril might better support the effects of sibutramine in obese patients with hypertension.