Obesity-related hypertension: its physiological basis and pharmacological approaches to its treatment.

Obesity-related hypertension is a common pathological disorder that can occur at any age and in any sex or race. Some of the metabolic, endocrinologic, adrenergic, and hemodynamic changes associated with this condition are reversed, in part, by weight reduction, which coincidentally decreases blood pressure (BP) in obese hypertensive patients. However, a major problem for obese hypertensives is dietary noncompliance. Consequently, a pharmacologic approach to obesity-related hypertension that meets the specific requirements of this complex pathological condition should be recommended when the initial nonpharmacological approach falls. Diuretics and beta-adrenergic blocking agents have been shown to be effective in decreasing BP in obese hypertensives, but they also decrease insulin sensitivity and increase cholesterol and lipoprotein concentrations. Calcium channel blockers, alpha 1-adrenoreceptor blocking, and angiotensin-converting enzyme inhibitor agents may offer an efficient and safe antihypertensive approach in obese hypertensive patients.