The Role of Sympatho-Inhibition in Combination Treatment of Obesity-Related Hypertension

Revathy Carnagarin, Cynthia Gregory, Omar Azzam, Graham S Hillis, Carl Schultz, Gerald F Watts, Damon Bell, Vance Matthews, Markus P Schlaich, Revathy Carnagarin, Cynthia Gregory, Omar Azzam, Graham S Hillis, Carl Schultz, Gerald F Watts, Damon Bell, Vance Matthews, Markus P Schlaich

Abstract

Obesity-related hypertension is commonly characterized by increased sympathetic nerve activity and is therefore acknowledged as a predominantly neurogenic form of hypertension. The sustained sympatho-excitation not only contributes to the rise in blood pressure but also elicits a vicious cycle which facilitates further weight gain and progression of associated co-morbidities. While weight loss and exercise remain at the forefront of therapy for obesity and obesity-related hypertension, the difficulties in achieving and maintaining long-term weight loss with lifestyle measures and the variable blood pressure response to weight loss often necessitate prescription of antihypertensive drug therapy. Remarkably, there are no specific recommendations for pharmacologic treatment for obese patients with arterial hypertension in any of the current guidelines and general principles of antihypertensive treatment are applied. The use of β-blockers and diuretics is commonly discouraged as first- or second-line therapy due to their unfavorable metabolic effects. This review explores evolving therapeutic strategies which based on their interference with pathophysiologic mechanism relevant in the context of obesity may guide optimized treatment of obesity-related hypertension.

Keywords: Antihypertensive medications; Obesity-related hypertension; Pathophysiology; Pharmacotherapy; Sympathetic activation.

References

    1. J Hypertens Suppl. 1999 Aug;17(3):S29-35
    1. Curr Pharm Des. 2004;10(29):3621-37
    1. Diabet Med. 1998 Jul;15(7):539-53
    1. Int J Obes (Lond). 2005 Jun;29(6):650-5
    1. J Hypertens. 2009 Feb;27(2):207-11
    1. Curr Hypertens Rep. 2000 Apr;2(2):139-47
    1. Am J Hypertens. 2001 Jul;14(7 Pt 1):694-8
    1. J Neuroendocrinol. 2008 May;20 Suppl 1:63-8
    1. J Clin Endocrinol Metab. 2011 Mar;96(3):E503-8
    1. JAMA. 1999 Oct 27;282(16):1523-9
    1. Am J Med. 2007 Oct;120(10):863-70
    1. Hypertension. 2000 Oct;36(4):538-42
    1. Int J Clin Pract. 2006 May;60(5):621-9
    1. N Engl J Med. 2009 Jan 1;360(1):44-52
    1. J Hypertens. 2005 Dec;23(12):2313-8
    1. J Hypertens. 2017 Oct;35(10 ):2059-2068
    1. N Engl J Med. 2000 Mar 30;342(13):905-12
    1. Int J Hypertens. 2013;2013:541689
    1. Arch Intern Med. 2002 Sep 9;162(16):1867-72
    1. J Clin Endocrinol Metab. 2005 Nov;90(11):5998-6005
    1. Lancet Diabetes Endocrinol. 2015 Feb;3(2):148-57
    1. Hypertension. 2003 Nov;42(5):878-84
    1. Circulation. 2009 Oct 20;120(16):1640-5
    1. Int J Obes Relat Metab Disord. 2002 Jan;26(1):48-57
    1. J Neuroendocrinol. 2008 May;20 Suppl 1:58-62
    1. Diabetes Obes Metab. 2006 Jul;8(4):456-65
    1. Diabetes Care. 2002 Nov;25(11):2088-97
    1. J Neuroendocrinol. 2008 May;20 Suppl 1:110-5
    1. Am J Cardiovasc Drugs. 2006;6(5):343-8
    1. BMJ. 1993 Aug 28;307(6903):537-40
    1. Curr Hypertens Rep. 2005 Oct;7(5):330-6
    1. Cardiol Rev. 2002 May-Jun;10(3):127-38
    1. Hypertension. 2006 Feb;47(2):296-308
    1. N Engl J Med. 2015 Nov 26;373(22):2117-28
    1. Crit Care Med. 2006 Apr;34(4):1243-6
    1. Am J Med Sci. 2002 Sep;324(3):127-37
    1. Hypertension. 2007 Jan;49(1):27-33
    1. Curr Opin Cardiol. 2001 Nov;16(6):317-27
    1. Circulation. 1998 Aug 25;98(8):772-6
    1. J Am Soc Nephrol. 2001 Mar;12(3):602-5
    1. J Hypertens. 2008 May;26(5):831-43
    1. Hypertension. 2001 Feb;37(2):250-4
    1. J Hypertens. 1999 Aug;17(8):1125-33
    1. J Hypertens. 2003 Sep;21(9):1709-17
    1. Circulation. 1994 Jan;89(1):493-8
    1. Hypertension. 2007 Nov;50(5):862-8
    1. J Hypertens Suppl. 1999 Aug;17(3):S41-54
    1. Ther Adv Endocrinol Metab. 2012 Jun;3(3):93-8
    1. J Hypertens. 2006 Aug;24(8):1633-9
    1. Curr Hypertens Rep. 2008 Jun;10(3):241-7

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir