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BMI impacts on efficacy of anti hypertensives

Body mass index may influence which blood pressure drugs work best at reducing the major cardiovascular complications of hypertension, according to a US study involving 11,482 people.

Diuretic drugs seem to be a reasonable choice for obese patients, but significantly increase the risk of CVD events in non-obese individuals.

Calcium channel blockers, meanwhile, work equally well in people in all weight groups, said the US researchers from the State University of New York.

They conducted a subanalysis of the international ACCOMPLISH trial that compared the impact of two single-pill drug combinations: the ACe inhibitor benazepril plus the diuretic hydrochlorothiazide, and benazepril plus the calcium channle blocker amlodipine.

The analysis showed that in people assigned to the diuretic combination a normal BMI was associated with significantly worse outcomes, a 68% higher event rate, than a high BMI.

In contrast, the benazepril and amlodipine combination was equally effective across all weight categories. What is more, compared with the diuretic regimen, the combination of benazepril and amlodipine significantly reduced heart-related events in normal weight and overweight individuals.

Both treatments worked as well in obese people, with no major difference in outcomes recorded between the two regimens.

The study authors said: “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.”

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