Article

Influence of obesity On Antihypertensive Therapy

Author : NS Neki, Neeraj Joshi, Jaswinder Singh, Pratibha Singla

Aim: To study the effect of obesity in the management of hypertension with ramipril and hydrochlorthiazide as compared to non-obese objects. Methodology: The study was undertaken in the department of Medicine, Govt. Medical College, Amritsar, India after taking permission from the ethical committee. This was an open study where the patient, the observer and the supervisor had clear knowledge of an anti-hypertensive drug used, which will avoid any physiological trauma to the patient as to what therapeutical trial is being done on him/her by using an unknown drug. 100 age and sex matched patients, 50 obese and 50 non obese, with both stage 1 and stage 2 hypertension (according to JNC 8 classification of hypertension), were selected at random from the outpatients clinics and in-door ward. Data for the above mentioned parameters were compiled, tabulated and statistically analysed for their significance. Utilising the student ʻtʼ test, ʻpʼ values were determined to finally evaluate the levels of significance. ʻpʼ value of <0.05 were considered significant. The relevance of the results in the light of stastical analysis are displayed and discussed. Results: Baseline mean systolic BP in obese patients was 172.4 7.08 .At the end of 6th week fall in systolic blood pressure was 135.59.31with a mean fall 36.9610.2 (p<0.001: highly significant). Baseline mean systolic BP in non-obese patients was 165.2 14.22. At the end of 6th week fall in systolic blood pressure was 111.85.22 with a mean fall 53.4011.8 (p<0.001: highly significant). Baseline mean diastolic BP in obese patients was 100.1 4.54. At the end of 6th week fall in diastolic blood pressure was 70.08 3.92 with a mean fall 22.04 5.83 (p<0.001: highly significant). Baseline mean diastolic BP in non-obese patients was 98.04 8.14. At the end of 6th week fall in diastolic blood pressure was 62.76 3.89 with a mean fall 35.28 6.72 (p<0.001: highly significant). Baseline MAP (mean arterial pressure) in obese patients was 124.2 4.44 (in supine position). At the end of 6th week fall in MAP was 97.21 4.82 with a mean fall in MAP 27.01 6.39 (p<0.001: highly significant). Baseline MAP (mean arterial pressure) in non-obese patients was 120.4 9.90 (in supine position). At the end of 6th week fall in MAP was 79.12 3.96 with a mean fall in MAP 41.32 7.88 (p<0.001: highly significant). Conclusion: There was fall in systolic, diastolic and mean arterial blood pressure in both age groups at the end of 6 weeks with a mean fall observed more in non-obese hypertensives than obese hypertensives. Average dose of ramipril required is more in obese hypertensives than in non-obese hypertensives to control the blood pressure. Average dose of hydrochlorthiazide required is more in obese hypertensives than in non-obese hypertensives to control the blood pressure. Treatment with angiotensin-converting enzyme inhibitors may show greater efficacy as monotherapy at lower doses compared with thiazide diuretics.


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