Title: Calcium Channel Blockers in Obesity-Related Hypertension
Volume: 10
Issue: 2
Author(s): Kazuko Masuo and Gavin W. Lambert
Affiliation:
Keywords:
Calcium channel blockers, hypertension, obesity, metabolic syndrome, ACCOMPLISH study, obesity-related hypertension, reninangiotensin-aldosterone system, insulin resistance and stimulated, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, ameliorative effects, dyslipidaemia, hyperglyaemia, beta-adrenoceptor antagonists, dihydropyridine, homeostatic model assessments of insulin resistance, lipolysis, Microalbuminuria, Cushing7apos;s syndrome, Pheochromocytoma, homeostasis, hypertriglyceridaemia, fibrinolysis, hyperinsulinamia, Hyperleptinaemia, thermogenesis, ancillary factor, thiazide, ricacidemia, achycardia, nicardipine, nisoldipine, manidipine, nilvadipine, benidipine, efonidipine, L-type calcium channel, T-type calcium channels, diltiazem, verapamil, euglycaemic hyperinsulinaemic clamp, placebo, PRAISE-2, congestive heart failure, cardiomyopathy, Nifedipine, proteinuria, renin-angiotensin, ameliorative effect
Abstract: Overweight and obesity are growing global health problems. The prevalence of hypertension and diabetes mellitus, frequently coexisting with obesity is increasing drastically, with all three (obesity, hypertension and diabetes) being strong risk factors for cardiovascular morbidity and mortality. In order to optimally reduce the risk for cardiovascular events in patients with obesity-related hypertension, optimal blood pressure control along with comprehensive lifestyle modification is required. Obesity and hypertension are characterized by elevated sympathetic activity as well as insulin resistance and the reninangiotensin- aldosterone system (RAAS) for the onset and development. Importantly, these characteristics, themselves, are one of the cardiovascular risks. Therefore, pharmacological treatments should be selected from favourable effects on elevated sympathetic nervous system activity, insulin resistance and stimulated RAAS. Current data suggests that angiotensin- converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARB) with or without a diuretic are recommended, because of their cardio- and renal-protective effects and favourable effects on insulin resistance and elevated sympathetic nervous activity. Most patients with obesity-related hypertension, however, are very resistant to control hypertension and frequently require two or more types of medications to achieve blood pressure goals. Several epidemiological (i.e. V-Heft III, ACCOMPLISH study, PRAISE study, PRAISE-2 study) and clinical studies have shown that calcium channel blockers (CCBs) are favourable for cardiac risk with neutral or ameliorative effects on insulin resistance and elevated sympathetic nervous activity.
