Praktické lekárnictvo 4/2016

Safe and effective antihypertensive therapy in obesity

Prevalence of arterial hypertension, which is in most cases resistant to standard therapy, is on the increase due to the obesity epidemic. Obesity is one of the main causes of hypertension, disrupting the efficacy of antihypertensive therapy. Obesity-related hypertension is triggered by an increase of sympathomimetic activity, an impaired renin-angiotensin-aldosterone system, hyperinsulinemia and hyperleptinemia. These pathophysiological alterations determine the appropriate choice of antihypertensive agents used. According to pharmacokinetic changes in obese patients, higher doses of antihypertensives are now required. The preferred agents are angiotensin-converting inhibitors or sartans. In multiple combinations, calcium channel blockers, small doses of diuretics, imidazoline receptor agonists and alpha and beta-receptor antagonists are also used. Excessive weight reduction and lifestyle modifications are essential parts of therapy.

Keywords: obesity, arterial hypertension, metabolic syndrom, antihypertensive drugs, pharmacokinetics