Two Sides to Every Coin

High blood pressure treatments should not necessarily include diuretics for obese patients

(RxWiki News) One study found evidence to support the use of diuretics in treating high blood pressure in obese patients. But this doesn’t mean that methodology works across the board.

A recent study tested two drug combinations on normal, overweight and obese patients with high blood pressure. The study found that taking a diuretic with their ACE inhibitor showed fewer heart attack and strokes in the obese group.

Yet, an outside doctor critiqued this study saying only in cases of left-ventricular dysfunction should a diuretic be used to treat high blood pressure.

"Talk to a doctor about your blood pressure treatment."

Michael Weber, MD, professor of medicine at Downstate Medical Center at State University of New York (SUNY), was the lead researcher of the investigation. For the study, 11,482 participants in need of blood pressure medication were evaluated and split into three groups based on weight: normal (1,616), overweight (4,157) and obese (5,709).

In each weight category patients were either given benazepril, which is an ACE inhibitor, and a diuretic called hydrochlorothiazide, or benazepril and amlodipine, which works as a calcium channel blocker.

Results were based on adverse heart-related events in patients: cardiovascular death, non-fatal heart attack or stroke.

Researchers found 68 percent more of the above-mentioned results in normal weight patients taking benazepril and hydrochlorothiazide compared to obese patients.

Dr. Weber said, “Diuretic-based regimens seem to be a reasonable choice in obese patients in whom excess volume provides a rationale for this type of treatment, but thiazides (diuretics) are clearly less protective against cardiovascular events in patients who are lean.”

No significant differences were found between weight groups with the benazepril and amlodipine combination.

When comparing the two medication groups, normal weight patients in the benazepril/amlodipine group had 43 percent less and overweight patients had 24 percent fewer heart-related events than the benazepril/diuretic group.

In a commentary on this study, also published in The Lancet, Dr. Franz Messerli, from Columbia University College of Physicians and Surgeons in New York, disagreed with these findings.

Dr. Messerli said for the treatment of hypertension, amlodipine-based treatments should be used no matter the body size of the patient.

Yet, if the goal is to prevent or treat left-ventricular dysfunction, a diuretic-based regimen should be used, no matter the body size of the patient.

Dr. Messerli recommended diuretics only be used to treat high blood pressure when patients are at risk for heart failure, which is the current guideline in the UK.

Dr. Weber said, “Our observations might not be fully generalisable to all types of treatments…since they were driven predominantly by findings in one (the diuretic-based) of our two treatment groups.”

Further studies would need to confirm Dr. Weber’s findings to influence treatment guidelines that recommend treating blood pressure with diuretics based on patient weight. This study was published in December in The Lancet. Novartis Pharmaceuticals provided funding. Drs. Weber and Bakris have worked as consultants for various pharmaceutical companies and other researchers involved are employees of Novartis Pharmaceuticals.

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Review Date: 
December 10, 2012