Blood pressure treatments aimed at preventing complications, such as heart attacks and strokes, work best if the doctor takes into account your body mass index (BMI), researchers from State University of New York’s Downstate Medical Center reported in The Lancet today.

The authors suggest that generally, obese patients respond best to diuretic medications, which should not be used with non-obese people with hypertension (high blood pressure), because of a considerably higher risk of cardiovascular events.

The researchers added that calcium channel blockers work well with either thin or fat people, as well as those of normal weight.

Research leader, Michael Weber, from the State University of New York’s Downstate Medical Center, said:

“These findings could change the way high blood pressure (hypertension) is treated and should be of practical help to clinicians in selecting the type of combination treatment most likely to benefit individual patients. Importantly, they suggest that hypertension in obese and lean patients is probably mediated by different forms of underlying disease processes.”

Weber and team set out to compare two drug combinations commonly used to treat hypertension over the long-term in patients at high risk of heart disease:

  • Benazepril (ACE inhibitor) plus the diuretic hydrochlorothiazide
  • And

  • Benazepril plus amlodipine (calcium channel blocker)

The team gathered and analyzed data from the international ACCOMPLISH trial. They grouped 11,482 patients into three BMI categories – normal weight, overweight, and obese. The ACCOMPLISH trial focused on comparing the same two hypertension treatment drug combinations.

The researchers found that:

  • Diuretic combination – those with a normal BMI had 68% more cardiovascular events than those with a high BMI
  • Calcium channel blocker combination – the treatment was equally effective in all BMI categories. Moreover, heart-related events were 43% lower than in the diuretic combination group among those with normal weight, and 24% less among overweight patients.

Among the obese patients, both treatments work equally well – the authors added that outcomes were similar too.

Weber believes that:

“Higher cardiovascular event rates in lean patients reported in hypertension clinical trials might have reflected the types of antihypertensive treatments that were used. 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 are clearly less protective against cardiovascular events in patients who are lean.

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.”

Franz Messerli from Columbia University College of Physicians and Surgeons in New York and Sripal Bangalore from New York University School of Medicine, New York wrote:

“If the indication is hypertension, amlodipine-based treatment should be used irrespective of body size. Conversely, if the indication is prevention or treatment of left-ventricular dysfunction, a diuretic based regimen should be used, again irrespective of body size.

This strategy relegates diuretics to third-line agents for treatment of hypertension, except in patients at risk of heart failure – a position recognised in the latest UK guidelines.”

Hypertension is one of the most researched medical conditions globally. Below are some examples of recent studies:

Written by Christian Nordqvist