CHICAGO — The angiotensin II blocker losartan, alone or in combination with the diuretic hydrochlorothiazide, appears efficacious in the treatment of obesity-associated hypertension, new data suggest.
Current guidelines—based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)—do not specify particular treatments for obesity-related hypertension or for the related metabolic syndrome.
The prominent role of angiotensin II in obesity-induced hypertension, however, suggests the possibility that angiotensin receptor blockade may be useful in its treatment, Dr. Suzanne Oparil said at the annual meeting of the American Society of Hypertension (ASH).
She presented preliminary data from a double-blind trial in which 261 patients from 51 sites were randomized to either placebo or losartan 50 mg/day for 4 weeks, titrated to 100 mg/day. Hydrochlorothiazide 12.5 mg/day was added in the active treatment group at week 8 and titrated to 25 mg/day at week 12.
At admission, the average body mass index was 37 kg/m
In all, 105 patients in each group completed the study, which was sponsored by Merck & Co. Inc., which has provided research support to Dr. Oparil.
Losartan 50 mg reduced the average sitting systolic BP to 140 mm Hg at week 4 and maintained it there through week 8. Adding hydrochlorothiazide to the 100-mg losartan dosage caused significant further reductions to about 133 mm Hg at week 16.
Similarly, losartan 50 mg decreased the average sitting diastolic BP to 90 mm Hg at week 4 through week 8. Add-on hydrochlorothiazide decreased the diastolic BP reading to about 85 mm Hg at week 18.
At week 16, 75% of patients on losartan achieved systolic BP control to less than 140 mm Hg, and 77% achieved diastolic BP control to less than 90 mm Hg.
In comparison, control rates for patients on placebo were 18% for systolic BP and 38% for diastolic.
All changes in the losartan group were significantly greater than those in the placebo group for all time points, said Dr. Oparil, president of the ASH and director of the vascular biology and hypertension program at the University of Alabama, Birmingham.
The losartan-based treatment regimen had a similar safety and tolerability profile as placebo, she said.
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