Weight-reducing drugs may be beneficial in hypertensive patients

Clinical question: 
How effective are weight-reducing drugs in hypertensive patients?
Bottom line: 
Although trials of orlistat and sibutramine in patients with elevated blood pressure demonstrated statistically significant decreases in weight, orlistat reduced blood pressure and sibutramine increased blood pressure.
Caveat: 
No long term mortality and morbidity RCT evidence is available for these drugs. Trials of rimonabant in this patient population could not be included.
Context: 
Orlistat, sibutramine and rimonabant are the main anti-obesity drugs in current use. Orlistat and sibutramine have been approved for long term treatment of obesity throughout much of the world. Rimonabant was approved for use in the European Union in 2006, and has also been approved in some South American and Asian countries. Rimonabant does not have US Food and Drug Administration (FDA) approval since preclinical and clinical data raised concerns about associations between rimonabant and increased frequency of psychiatric adverse events, including suicidality, an ill-defined constellation of neurological signs and symptoms, and seizures.¹ In January 2009, the European Commission issued a decision to withdraw market authorisation for rimonabant in all countries of the European Union.² 1.Food, Drug Administration. Egan AG. Colman EG. www.fda.gov/ohrms/dockets/AC/07/briefing/2007‐4306b1fda‐backgrounder.pdf 2.European Medicines Agency. www.emea.europa.eu/humandocs/PDFs/EPAR/acomplia/3945709en.pdf
Review CD#: 
CD007654
PEARLS No: 
208
Date: 
November, 2009
Authored by: 
Brian R McAvoy