Managing BP in Obese Patients: Is One Drug Better than Another?

the MPR take:

Does selection of a particular class of blood pressure-lowering drug lead to a significantly different outcome for obese patients compared to those with a lower body mass index (BMI)? Patient data from 135,715 individuals from 22 clinical trials and 14,353 major cardiovascular events in the Blood Pressure Lowering Treatment Trialists’ Collaboration was reviewed to compare the effects of different classes of blood pressure-lowering regiments for the primary outcome of total major cardiovascular events, including comparisons between patient subgroups based on BMI. ACE inhibitors, calcium antagonists, diuretics, and beta-blockers were included in the study, along with more vs. less intensive regimen comparisons. Benefits of blood pressure lowering for individuals across BMI subgroups were evident, but no evidence was seen that a particular drug class was substantially more or less effective among patients with varying BMIs. A small additional benefit was seen with ACE inhibitors in patients with a higher BMI, although the evidence is weak and could be due to chance, the researchers noted. Until further clinical trials are conducted, there are no particular blood pressure-lowering drug classes that are superior to others for obese patients.

The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI).