Hindsight: Blood Pressure-Lowering Effects of Orlistat

Alain Golay, chef du Service d'enseignement thérapeutique aux Hôpitaux Universitaires Genevois

Alain Golay, chef du Service d'enseignement thérapeutique aux Hôpitaux Universitaires Genevois

Given my growing interest in obesity related hypertension, it was not a long shot to wonder how exactly pharmacologically induced weight loss would affect blood pressure.

Thus, in a paper published in the Journal of Hypertension back in 2002, Alain Golay from the University Hospital in Geneva and I examined the effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension.

Out meta-analysis included data from five multicenter, randomized, placebo-controlled studies, conducted in Europe and the USA, of at least 12 month duration.

We specifically looked at the changes in blood pressure in participants with uncontrolled diastolic hypertension or isolated systolic hypertension.

Using an intent-to-treat analysis, we pooled data from 628 patients, whereby (as expected) the orlistat-treated participants lost significantly more body weight than placebo recipients (8.0 versus 4.0% of initial weight).

In individuals with ISH, mean systolic pressure dropped by 9.4 mmHg in the orlistat group versus 4.6 in the placebo group; In those with diastolic hypertension, blood pressure on orlistat decreased by 7.7 mmHg versus 5.6 mmHg on placebo.

To put these blood pressure changes into perspective – a mean drop in 10 and 5 mmHg in systolic and diastolic blood pressure, respectively, is generally what is seen with anti-hypertensive monotherapy – so not a bad result for a drug that helped participants achieve (and sustain) a rather modest weight loss.

As it is hard to come up with any other explanation for the drop in blood pressure with orlistat other than weight loss, this study certainly goes to show just how sensitive blood pressure is to excess weight and why weight management continues to be a recommendation in all hypertension guidelines, even if these guidelines seldom explain exactly how such a reduction in body weight can be achieved or maintained.

Nevertheless, as outlined in previous posts, hypertension continues to be one of the most common complications of excess weight – and a reduction in elevated blood pressure continues to be one of the most common benefits of even modest reductions in body weight.

According to Google Scholar, this paper has been cited 51 times.

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