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The Role of Sympatho-Inhibition in Combination Treatment of Obesity-Related Hypertension

  • Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)
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Abstract

Obesity-related hypertension is commonly characterized by increased sympathetic nerve activity and is therefore acknowledged as a predominantly neurogenic form of hypertension. The sustained sympatho-excitation not only contributes to the rise in blood pressure but also elicits a vicious cycle which facilitates further weight gain and progression of associated co-morbidities. While weight loss and exercise remain at the forefront of therapy for obesity and obesity-related hypertension, the difficulties in achieving and maintaining long-term weight loss with lifestyle measures and the variable blood pressure response to weight loss often necessitate prescription of antihypertensive drug therapy. Remarkably, there are no specific recommendations for pharmacologic treatment for obese patients with arterial hypertension in any of the current guidelines and general principles of antihypertensive treatment are applied. The use of β-blockers and diuretics is commonly discouraged as first- or second-line therapy due to their unfavorable metabolic effects. This review explores evolving therapeutic strategies which based on their interference with pathophysiologic mechanism relevant in the context of obesity may guide optimized treatment of obesity-related hypertension.

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Authors and Affiliations

  1. Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia

    Revathy Carnagarin, Cynthia Gregory, Omar Azzam, Graham S. Hillis, Carl Schultz, Gerald F. Watts, Damon Bell, Vance Matthews & Markus P. Schlaich

  2. Department of Cardiology, Royal Perth Hospital, Perth, Australia

    Graham S. Hillis, Carl Schultz, Gerald F. Watts, Damon Bell & Markus P. Schlaich

  3. Department of Nephrology, Royal Perth Hospital, Perth, Australia

    Markus P. Schlaich

Authors
  1. Revathy Carnagarin
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  2. Cynthia Gregory
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  3. Omar Azzam
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  4. Graham S. Hillis
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  5. Carl Schultz
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  8. Vance Matthews
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  9. Markus P. Schlaich
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Correspondence to Markus P. Schlaich.

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Conflict of Interest

Dr. Schlaich is supported by an NHMRC Research Fellowship and has received consulting fees, and/or research support from Abbott. Dr. Schultz reports grants from Abbott vascular, personal fees from Abbot vascular, outside the submitted work. None of the other authors declare any conflict of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action

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Carnagarin, R., Gregory, C., Azzam, O. et al. The Role of Sympatho-Inhibition in Combination Treatment of Obesity-Related Hypertension. Curr Hypertens Rep 19, 99 (2017). https://doi.org/10.1007/s11906-017-0795-1

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