(Hypertension. 2001;37:250.)
© 2001 American Heart Association, Inc.
Scientific Contributions |
From the Franz Volhard Clinic and Max Delbrück Center for Molecular Medicine, Medical Faculty of the Charité, Humboldt University, Berlin, Germany.
Correspondence to Arya M. Sharma, MD, Franz Volhard Clinic, Wiltbergstrasse 50,13125, Berlin, Germany. E-mail sharma{at}fvk-berlin.de
| Abstract |
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6 months, body weight was higher in the
ß-blocker than in the control group at the end of the study. The
median difference in body weight was 1.2 kg (range -0.4 to 3.5 kg). A
regression analysis suggested that ß-blockers were associated
with an initial weight gain during the first few months. Thereafter, no
further weight gain compared with controls was apparent. There was no
relationship between demographic characteristics and changes in body
weight. Based on these observations, the first-line use of ß-blockers
in obese hypertensive patients should be reviewed. Obesity management
in overweight hypertensive patients may be more difficult in the face
of ß-blocker treatment.
Key Words: obesity ß-blockers body weight hypertension, obesity
| Introduction |
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| Magnitude of ß-BlockerAssociated Weight Gain |
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The characteristics and changes in body weight in the selected studies are summarized in Table 1. Together, these trials included a total of 7048 patients, of whom 3205 received ß-blocker therapy. The patients were followed over time periods that ranged from 6 months to 10 years. In 7 of the 8 trials, body weight was greater in the ß-blocker group than in the control group at the end of the study (Figure 1). The median difference in weight between the ß-blocker and control groups was 1.2 kg (range -0.4 to 3.5 kg). There was no relationship between any demographic characteristic and the ß-blockerinduced change in body weight. Thus, all patients appeared susceptible to weight gain when they received a ß-blocker.
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| Time Course of ß-BlockerAssociated Weight Gain |
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| Potential Mechanisms |
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Apart from their direct metabolic effects,12 ß-blockers may also have a negative impact on total energy expenditure by increasing feelings of tiredness and decreasing anxiety. Such effects reduce so-called purposeless movement, or "fidgeting." This nonexercise-associated thermogenesis (NEAT) was recently shown to play a major role in the metabolic response to overeating. A low NEAT has been associated with remarkable weight gains in normal individuals.26 ß-Blockers also have negative effects on maximal and submaximal exercise capacity, which should be considered when prescribing ß-blockers to physically active hypertensive patients.27
Together, these effects of ß-blockers reduce total energy expenditure by only 5% or 10%, which corresponds to 100 to 200 kcal/d. However, this reduction could easily account for the 1- to 3.5-kg weight gain observed in clinical studies. A constant reduction in energy expenditure will not be associated with a continuing weight gain. Instead, an energy expenditure reduction unaccompanied by an energy intake reduction will result in weight gain until the positive energy balance is neutralized by the increased metabolic demand of increased tissue mass.28 This result is consistent with the observation that weight gain is apparent during the early months of ß-blockade. Thus, patients will achieve and maintain a new steady state at a higher body weight that counteracts the reduction in energy expenditure attributable to ß-blockade. In this context, ß3-adrenergic agonists are currently under clinical investigation for use as antiobesity agents.29
The ability to lose weight is obviously directly dependent on the ability to mobilize fat stores. However, ß-blockade is also known to inhibit lipolysis in response to adrenergic stimulation.30 Thus, systemic ß-blockade may promote weight gain at least in part by inhibiting ß-agonistinduced lipolysis. This feature would make it more difficult for individuals to lose weight under ß-blockade.
| Individual Susceptibility |
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| Clinical Significance |
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| Potential Management Implications |
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| Areas for Future Research |
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In summary, we find that effects on body weight are generally ignored in randomized studies of antihypertensive medication. The available evidence indicates that ß-blocker treatment is often associated with a 0.5- to 3.5-kg increase in body weight after 6 to 12 months of treatment compared with other antihypertensive agents. When ß-blockers are specifically indicated, the drugs should be given regardless of the effects on body weight. However, our data imply that weight control under ß-blockade may be more difficult and requires greater attention from the patient, the nutritionist, and the physician.
Received July 10, 2000; first decision July 31, 2000; accepted August 16, 2000.
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