European Joint Statement on Obesity and HypertensionFriday, May 11, 2012
As regular reader may recall, this week I am attending the 19th European Congress on Obesity, where, this morning, I spoke in a joint session of the European Association for the Study of Obesity (EASO) and the European Society of Hypertension (ESH).
Interestingly enough, today also saw the online release of a Joint statement of EASO and ESH on obesity and difficult to treat arterial hypertension in the Journal of Hypertension.
As discussed by Jens Jordan, lead author of this statement (and a close collaborator from my time back in Berlin), obese individuals are not only more prone to arterial hypertension, and despite requiring more antihypertensive medications, have an increased risk of treatment-resistant arterial hypertension.
However, it is also important that there is considerable inter-individual variability in the relationship between excess weight and hypertension – many obese people are normotensive or have uncomplicated mild hypertension. These differences may perhaps be related to genetic mechanisms, as having a positive family history of hypertension is certainly an important risk factor.
Although, weight loss is often recommended as a means to lower blood pressure, current hypertension guidelines fail to provide evidence-based guidance on how to institute (or maintain) weight loss.
Furthermore, there is emerging evidence that perhaps the influences of weight loss on blood pressure may be overestimated.
Thus, although hypertension generally decreases following bariatric surgery, many patients tend to experience subsequent increases in their blood pressure and will generally again require antihypertensive medications a few years after surgery.
Jordan also pointed out that data from large-scale studies with hard clinical endpoints on antihypertensive medications specifically addressing obese patients are lacking and the morbidity from the growing population of severely obese patients is poorly recognized or addressed.
Although renin-angiotensin system inhibitors are widely considered to be the most appropriate drugs for antihypertensive treatment of obese patients, most will likely require two or more antihypertensive drugs.
It also remains unclear how best to combine weight loss strategies and antihypertensive treatment to achieve an optimal clinical outcome.
This state of affairs is not very different from that of over a decade ago, where I already deplored the lack of specific studies and/or guidelines on the management of hypertension in obese patients.
Perhaps, this joint statement, which is not only an important indication that these two organisations are talking, may help drive initiatives that will ultimately help improve obesity related hypertension management.
Jordan J, Yumuk V, Schlaich M, Nilsson PM, Zahorska-Markiewicz B, Grassi G, Schmieder RE, Engeli S, & Finer N (2012). Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and difficult to treat arterial hypertension. Journal of hypertension, 30 (6), 1047-1055 PMID: 22573071