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(Hypertension. 2001;38:705.)
© 2001 American Heart Association, Inc.

Obesity- and Diabetes-Related Hypertension

Treatment of Obesity Hypertension and Diabetes Syndrome

Maria Teresa Zanella; Osvaldo Kohlmann, Jr; Artur Beltrame Ribeiro

From the Nephrology and Endocrinology Divisions, Hospital do Rim e Hipertensão, Federal University of São Paulo, São Paulo, Brasil.

Correspondence to Maria Teresa Zanella, Hospital do Rim e Hipertensão, Federal University of São Paulo, Rua Borges Lagoa 960, 04038-002 São Paulo SP, Brasil. E-mail tereza.zanella{at}rimehipertensao.com.br

Abstract

Abstract—— Obesity has been shown to be an independent risk factor for coronary heart disease. The insulin resistance associated with obesity contributes to the development of other cardiovascular risk factors, including dyslipidemia, hypertension, and type 2 diabetes. The coexistence of hypertension and diabetes increases the risk for macrovascular and microvascular complications, thus predisposing patients to cardiac death, congestive heart failure, coronary heart disease, cerebral and peripheral vascular diseases, nephropathy, and retinopathy. Body weight reduction increases insulin sensitivity and improves both blood glucose and blood pressure control. Metformin therapy also improves insulin sensitivity and has been associated with decreases in cardiovascular events in obese diabetic patients. Antihypertensive treatment in diabetics decreases cardiovascular mortality and slows the decline in glomerular function. However, pharmacological treatment should take into account the effects of the antihypertensive agents on insulin sensitivity and lipid profile. Diuretics and ß-blockers are reported to reduce insulin sensitivity and increase triglyceride levels, whereas calcium channel blockers are metabolically neutral and ACE inhibitors increase insulin sensitivity. For the high-risk hypertensive diabetic patients, ACE inhibition has proven to confer additional renal and vascular protection. Because hypertension and glycemic control are very important determinants of cardiovascular outcome in obese diabetic hypertensive patients, weight reduction, physical exercise, and a combination of antihypertensive and insulin sensitizers agents are strongly recommended to achieve target blood pressure and glucose levels.

Key Words: obesity • diabetes • drug therapy

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