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Weight-reducing drug therapy and hypertension

Julia Schimkus and Jurgen Scholze

The obesity epidemic is closely associated with a prominent rise in the incidence of hypertension, and both obesity and hypertension independently cause a major increase in cardiovascular risk. To reduce body weight, nonpharmacological approaches have limited success, and adjuvant pharmacotherapy is often required for effective weight reduction and maintenance of reduced body weight. In this literature review, we examined the clinical effect of the anti-obesity drugs orlistat, rimonabant and sibutramine on blood pressure, and if this effect was attributed to a change in body weight. We found a blood pressure decrease under treatment with orlistat and rimonabant, which was more pronounced in subjects with pre-existing hypertension. The decrease in blood pressure corresponded to the loss of body weight and waist circumference, with no evidence of a substance-specifi c effect beyond that. Findings for sibutramine were more complex. Sibutramine has central sympatholytic and peripheral sympathomimetic effects. The peripheral sympathomimetic effects, via norepinephrine reuptake inhibition, may slightly increase the blood pressure in normotensive subjects with a relatively low central sympathetic drive. By contrast, the central sympatholytic effects of sibutramine may predominate in hypertensive patients with a high sympathetic tone, leading to sustained reductions in blood pressure.