European Society of Hypertension Working Group on Obesity: obesity drugs and cardiovascular outcomes

The prevalence of obesity-related hypertension among middle-aged and older adults in China

Objective

The aim of our study was to assess the prevalence and geographic variation of obesity-related hypertension in China among adults aged 45 years or older.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015. Stratified sample households covered 150 counties/districts and 450 villages/urban communities from 28 provinces by using household questionnaires, clinical measurements, and blood-based bioassays. A multivariable non-conditional logistic regression model was used to analyze the risk factors correlated with obesity-related hypertension.

Results

The prevalence of obesity-related hypertension was 22.7%, ~120 million people, among adults aged 45 years or older in China. For people in the age ranges of 45-54, 55-64, 65-74, and ≥75 years, the prevalence of obesity-related hypertension was 16.7, 24.3, 27, and 26.7%, respectively, and the prevalence of obesity-related hypertension among hypertensive participants was 66.0, 60.9, 54.2, and 47.3%, respectively. Compared with non-obesity-related hypertension, the obesity-related hypertensive patients had a higher prevalence of diabetes mellitus, dyslipidemia, and hyperuricemia (all P < 0.0001). The prevalence of obesity-related hypertension showed a decreasing gradient from north to south and from east to west. Multivariate logistic regression analysis showed that female gender, living in urban areas, diabetes mellitus, dyslipidemia, and hyperuricemia were positively correlated with obesity-related hypertension.

Conclusion

The prevalence of obesity-related hypertension among adults aged 45 years or older was high in China. Among hypertensive participants, older age was negatively correlated with obesity-related hypertension. Obesity-related hypertensive participants are more prone to aggregation of risk factors of atherosclerotic cardiovascular disease.

Overview of bariatric surgery for the physician

The worldwide pandemic of obesity carries alarming health and socioeconomic implications. Bariatric surgery is currently the only effective treatment for severe obesity. It is safe, with mortality comparable to that of cholecystectomy, and effective in producing substantial and sustainable weight loss, along with high rates of resolution of associated comorbidities, including type 2 diabetes. For this reason, indications for bariatric surgery are being widened. In addition to volume restriction and malabsorption, bariatric surgery brings about neurohormonal changes that affect satiety and glucose homeostasis. Increased understanding of these mechanisms will help realise therapeutic benefits by pharmacological means. Bariatric surgery improves long-term mortality but can cause long-term nutritional deficiencies. The safety of pregnancy after bariatric surgery is still being elucidated.

Is drug utilization in Greece sex dependent? A population-based study

Despite scarce data pertaining to prescription drug sales in Greece, the lack of large-scale epidemiological studies has made it difficult to elaborate on putative differences regarding drug consumption patterns between the two sexes. Herein, we sought to investigate whether sex may have an impact on medication trends of the Greek population. The data reported are part of a survey conducted under the auspices of the National Center for Social Research. Information was collected from 2499 Athenian citizens. Probability of drug use was assessed through Pearson chi-square (χ(2) ) test and logistic regression was implemented to clarify whether sex or other socio-economic and morbidity factors may influence drug utilization. Women consumed more drugs as compared to men. Sex proved to be a differentiating factor influencing the use of analgesic/non-steroidal anti-inflammatory drugs, cardiovascular, anxiolytic and antidepressant drugs, as well as drugs for the treatment of thyroid diseases and osteoporosis. Present results further implicate other socio-economic factors (e.g. education, employment and financial status) in the harnessing of drug use in Greece. To the best of our knowledge, this is the largest pharmacoepidemiological study to report that Greek women consume more drugs and present different medication patterns, as compared to men. Further research is considered imperative in order for the awareness of prescribers, policy-makers and the general public on this sensitive matter to be increased.

Central and peripheral cannabinoid receptors as therapeutic targets in the control of food intake and body weight

The endocannabinoid system consists of lipid-derived agonists that activate cannabinoid (CB) receptors. CB receptor agonists, namely, the phytocannabinoid Δ(9)-THC and the endocannabinoid anandamide, increase hunger sensation and food intake. These discoveries led to the clinical use of Δ(9)-THC derivatives for the treatment of cancer and HIV-related nausea and cachexia. Animal studies clarified the important role of CB1 receptors in the hypothalamus and in the limbic system in mediating orexigenic effects. In parallel, data on CB1-specific blockade either by drugs or by genetic ablation further demonstrated that CB1 inhibition protects against weight gain induced by high-fat feeding and reduces body weight in obese animals and humans. The mechanisms of weight reduction by CB1 blockade are complex: they comprise interactions with several orexigenic and anorexigenic neuropeptides and hormones, regulation of sympathetic activity, influences on mitochondrial function, and on lipogenesis. Although these mechanisms appear to be mainly mediated by the CNS, weight loss also occurs when drugs that do not reach CNS concentrations sufficient to inhibit CB1 signaling are used. The development of peripherally restricted CB1 inverse agonists and antagonists opened new routes in CB1 pharmacology because centrally acting CB1 inverse agonists, e.g., rimonabant and taranabant, exerted unacceptable side effects that precluded their further development and application as weight loss drugs. Tissue and circulating endocannabinoid concentrations are often increased in animal models of obesity and in obese humans, especially those with visceral fat accumulation. Thus, further research on CB1 inhibition is still promising to treat human obesity.

Is there a path for approval of an antiobesity drug: what did the Sibutramine Cardiovascular Outcomes Trial find?

PURPOSE OF REVIEW

Obesity continues to increase in prevalence in the USA and throughout the world. It is clearly a major contributor to morbidity and mortality. Unfortunately, effective prevention strategies are few. As a contributor to cardiovascular disease, obesity is an important treatment objective. However, before approval, all drugs must meet safety and efficacy concerns of the US Food and Drug Administration.

RECENT FINDINGS

Since July 2010, the Food and Drug Administration's Endocrine and Metabolic Advisory Committee has reviewed three new drug applications and one previously approved drug for the treatment of obesity. This review examines in detail the Advisory Committee's consideration of the risk-benefit equation of the four drugs with a concentration on sibutramine and its key study, Sibutramine Cardiovascular Outcomes Trial.

SUMMARY

Future development of drugs for the treatment of obesity will be dependent on whether they can survive review for safety and effectiveness. The Food and Drug Administration continues to be highly concerned with proposed obesity drugs increasing cardiovascular or any risks and may require changes to clinical research protocols.

The ACQUIRE trial

Achievement of goal blood pressure values, particularly in high-risk categories of patients, still remains an unmet goal of the therapeutic approach to hypertension. The same conclusion can be drawn for patient adherence to antihypertensive drugs, which is a variable of major relevance for obtaining optimal blood pressure control in treated hypertensives. The ACQUIRE study has recently evaluated the efficacy and safety profile of either aliskiren monotherapy or aliskiren/hydrochlorothiazide combination treatment in a consistent number of stage 2 hypertensive patients, half of them complicated by obesity. The results show the effectiveness of aliskiren, particularly when combined with hydrochlothiazide, in achieving satisfactory blood pressure control. This is particularly the case for systolic blood pressure values, which have a major detrimental impact on cardiovascular risk profile and on cardiovascular events. The combination drug regimen, which can achieve early blood pressure control, was accompanied by an excellent side-effect and safety profile and thus was associated with a high adherence to treatment.