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Yang S, Zhou Z, Miao H, Zhang Y. Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2023; 25:404-415. [PMID: 37141231 PMCID: PMC10184479 DOI: 10.1111/jch.14661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
To determine quantitative differences between weight loss and changes in clinic blood pressure (BP) and ambulatory BP in patients with obesity or overweight, the authors performed a meta-analysis. PubMed, Embase, and Scopus databases were searched up to June 2022. Studies that compared clinic or ambulatory BP with weight loss were included. A random effect model was applied to pool the differences between clinic BP and ambulatory BP. Thirty-five studies, for a total of 3219 patients were included in this meta-analysis. The clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly reduced by 5.79 mmHg (95% CI, 3.54-8.05) and 3.36 mmHg (95% CI, 1.93-4.75) after a mean body mass index (BMI) reduction of 2.27 kg/m2 , and the SBP and DBP were significantly reduced by 6.65 mmHg (95% CI, 5.16-8.14) and 3.63 mmHg (95% CI, 2.03-5.24) after a mean BMI reduction of 4.12 kg/m2 . The BP reductions were much larger in patients with a BMI decrease ≥3 kg/m2 than in patients with less BMI decrease, both for clinic SBP [8.54 mmHg (95% CI, 4.62-12.47)] versus [3.83 mmHg (95% CI, 1.22-6.45)] and clinic DBP [3.45 mmHg (95% CI, 1.59-5.30)] versus [3.15 mmHg (95% CI, 1.21-5.10)]. The significant reduction of the clinic and ambulatory BP followed the weight loss, and this phenomenon could be more notable after medical intervention and a larger weight loss.
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Affiliation(s)
- Shijie Yang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhanyang Zhou
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanhuan Miao
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Bentzen BH, Grunnet M, Hyveled-Nielsen L, Sundgreen C, Lassen JB, Hansen HH. Anti-hypertensive treatment preserves appetite suppression while preventing cardiovascular adverse effects of tesofensine in rats. Obesity (Silver Spring) 2013; 21:985-92. [PMID: 23784901 DOI: 10.1002/oby.20122] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 09/10/2012] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Tesofensine is a novel triple monoamine reuptake inhibitor which is in development for the treatment of obesity. Preclinical and clinical data suggest that appetite suppression is an important mechanism by which tesofensine exerts its robust weight reducing effect. Notably, the strong hypophagic response to tesofensine treatment is demonstrated to be linked to central stimulation of noradrenergic and dopaminergic neurotransmission. The sympathomimetic mode of action of tesofensine may also associate with the elevated heart rate and blood pressure observed in clinical settings, and we therefore sought experimentally to address this issue. DESIGN AND METHODS The anorexigenic and cardiovascular effects of tesofensine were studied simultaneously in telemetrized conscious rats in a combined real-time food intake and cardiovascular telemetry monitoring system. RESULTS Acute administration of tesofensine caused a dose-dependent hypophagic effect as well as increased heart rate and blood pressure. Interestingly, combined treatment with metoprolol (b1 adrenoceptor blocker, 10-20 mg/kg, p.o.) fully prevented the cardiovascular sympathetic effects of tesofensine while leaving the robust inhibitory efficacy on food intake unaffected. Similarly, the angiotensin AT1 receptor antagonist telmisartan (1.0-3.0 mg/kg, p.o.) did not interfere with the anti-obesity effects of tesofensine, however, telmisartan only partially reversed the increase in systolic blood pressure and had no effect on the elevated heart rate induced by tesofensine. CONCLUSION These data suggests that tesofensine causes elevations in heart rate and blood pressure by increasing sympathetic activity, and that different adrenoceptor subtypes may be responsible for the anti-obesity and cardiovascular effects of tesofensine.
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Brod M, Hammer M, Kragh N, Lessard S, Bushnell DM. Development and validation of the Treatment Related Impact Measure of Weight (TRIM-Weight). Health Qual Life Outcomes 2010; 8:19. [PMID: 20137088 PMCID: PMC2841109 DOI: 10.1186/1477-7525-8-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 02/05/2010] [Indexed: 11/10/2022] Open
Abstract
Background The use of prescription anti-obesity medication (AOM) is becoming increasingly common as treatment options grow and become more accessible. However, AOM may not be without a wide range of potentially negative impacts on patient functioning and well being. The Treatment Related Impact Measure (TRIM-Weight) is an obesity treatment-specific patient reported outcomes (PRO) measure designed to assess the key impacts of prescription anti-obesity medication. This paper will present the validation findings for the TRIM-Weight. Methods The online validation battery survey was administered in four countries (the U.S., U.K., Australia, and Canada). Eligible subjects were over age eighteen, currently taking a prescription AOM and were currently or had been obese during their life. Validation analyses were conducted according to an a priori statistical analysis plan. Item level psychometric and conceptual criteria were used to refine and reduce the preliminary item pool and factor analysis to identify structural domains was performed. Reliability and validity testing was then performed and the minimally importance difference (MID) explored. Results Two hundred and eight subjects completed the survey. Twenty-one of the 43 items were dropped and a five-factor structure was achieved: Daily Life, Weight Management, Treatment Burden, Experience of Side Effects, and Psychological Health. A-priori criteria for internal consistency and test-retest coefficients for the total score and all five subscales were met. All pre-specified hypotheses for convergent and known group validity were also met with the exception of the domain of Daily Life (proven in an ad hoc analysis) as well as the 1/2 standard deviation threshold for the MID. Conclusion The development and validation of the TRIM-Weight has been conducted according to well-defined principles for the creation of a PRO measure. Based on the evidence to date, the TRIM-Weight can be considered a brief, conceptually sound, valid and reliable PRO measure.
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Affiliation(s)
- Meryl Brod
- The Brod Group, 219 Julia Avenue, Mill Valley, California 94941, USA.
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Nakou E, Filippatos TD, Liberopoulos EN, Tselepis AD, Kiortsis DN, Mikhailidis DP, Elisaf MS. Effects of sibutramine plus verapamil sustained release/trandolapril combination on blood pressure and metabolic variables in obese hypertensive patients. Expert Opin Pharmacother 2008; 9:1629-39. [PMID: 18570597 DOI: 10.1517/14656566.9.10.1629] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The management of obese hypertensive subjects may require the administration of anti-obesity and antihypertensive drugs. Sibutramine use has raised concerns regarding a potential increase in subjects' blood pressure and heart rate. The primary end-points of this study were an evaluation of the effect of sibutramine together with a verapamil sustained release/trandolapril combination tablet versus verapamil sustained release/trandolapril alone on the blood pressure and heart rate in obese hypertensive patients. RESEARCH DESIGN/METHODS Patients received a low-fat low-calorie diet and were randomly allocated to open-label verapamil sustained release/trandolapril 180/2 mg (n = 26) or sibutramine 10 mg together with verapamil sustained release/trandolapril 180/2 mg (n = 28) daily for 6 months. RESULTS Significant reductions in the subjects' systolic blood pressure and diastolic blood pressure were observed in both groups (p < 0.01 versus baseline). At 6 months a greater fall in blood pressure was observed in the sibutramine/verapamil sustained release/trandolapril group compared with the verapamil sustained release/trandolapril group (systolic blood pressure 21.9 +/- 8.1 versus 15.9 +/- 12.3 mmHg and diastolic blood pressure 15.7 +/- 8.1 versus 9.1 +/- 9.9 mmHg) but this was only significant (p = 0.03) for diastolic blood pressure. The subjects' heart rate did not change significantly in any group. No significant sibutramine-associated attenuation of blood pressure reduction was observed during the study. The sibutramine/verapamil sustained release/trandolapril treatment resulted in significantly greater improvement in the subjects' anthropometric variables, homeostasis model assessment and lipid profiles compared with verapamil sustained release/trandolapril administration. The subjects' small dense low-density lipoprotein cholesterol, high-sensitivity C-reactive protein and visfatin plasma levels were only measured in the sibutramine/verapamil sustained release/trandolapril group (all decreased by p < 0.05 versus baseline). CONCLUSIONS The sibutramine/verapamil sustained release/trandolapril combination in obese hypertensive patients significantly reduced their blood pressure and improved their anthropometric and metabolic variables without affecting the heart rate.
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Affiliation(s)
- E Nakou
- University of Ioannina, Department of Internal Medicine, School of Medicine, 45 110 Ioannina, Greece.
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Sharma B, Henderson DC. Sibutramine: current status as an anti-obesity drug and its future perspectives. Expert Opin Pharmacother 2008; 9:2161-73. [DOI: 10.1517/14656566.9.12.2161] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Florentin M, Liberopoulos EN, Elisaf MS. Sibutramine-associated adverse effects: a practical guide for its safe use. Obes Rev 2008; 9:378-87. [PMID: 18034790 DOI: 10.1111/j.1467-789x.2007.00425.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity is a multifactorial chronic disorder which comprises a serious health problem nowadays. The effective management of obesity is difficult in contemporary societies where abundance of hypercaloric food and sedentary lifestyle is the rule. Apart from lifestyle interventions, which include diet, exercise and behavioural treatment, weight-loss medications can also be used for the management of obesity. Sibutramine, a selective monoamine reuptake inhibitor, is a drug with established efficacy in sustained weight reduction and an overall favourable safety profile. However, its action on the sympathetic nervous system has linked sibutramine to blood pressure and heart rate elevations. These potentially adverse effects as well as other sibutramine-associated side effects and their possible underlying mechanisms are reviewed in the present article. Compelling evidence from the majority of data in the literature shows that sibutramine can be effectively used in conjunction with caloric restriction and exercise in obese patients. Hypertension, if adequately treated and frequently monitored, is not an absolute contraindication for the prescription of sibutramine.
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Affiliation(s)
- M Florentin
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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de Simone G, D'Addeo G. Sibutramine: balancing weight loss benefit and possible cardiovascular risk. Nutr Metab Cardiovasc Dis 2008; 18:337-341. [PMID: 18502626 DOI: 10.1016/j.numecd.2008.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 03/19/2008] [Accepted: 03/21/2008] [Indexed: 11/28/2022]
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Does it matter how we lower blood pressure in obese hypertensive patients? Curr Hypertens Rep 2008; 10:10-1. [DOI: 10.1007/s11906-008-0004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Torp-Pedersen C, Caterson I, Coutinho W, Finer N, Van Gaal L, Maggioni A, Sharma A, Brisco W, Deaton R, Shepherd G, James P. Cardiovascular responses to weight management and sibutramine in high-risk subjects: an analysis from the SCOUT trial. Eur Heart J 2007; 28:2915-23. [PMID: 17595194 DOI: 10.1093/eurheartj/ehm217] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The Sibutramine Cardiovascular OUTcomes (SCOUT) trial is a randomized, double-blind comparison of sibutramine vs. placebo, in addition to standard care for weight management, in overweight/obese subjects with an increased risk of cardiovascular disease. The study had an initial single-blind, 6-week lead-in period with sibutramine plus weight management. We report the cardiovascular responses and weight loss during this period. METHODS AND RESULTS A total of 10,742 subjects received treatment in the lead-in period; 97% had cardiovascular disease, 88% hypertension and 84% type 2 diabetes. Body weight decreased (median 2.2 kg [5th, 95th percentile changes -6.2, 0.5]); waist circumference was reduced by 2.0 cm (men: -8.5, 2.9; women: -9.0, 3.0), systolic blood pressure fell by 3.0 mmHg (-23.5, 12.5) and diastolic by 1.0 mmHg (-13.5, 10.0). Pulse rate increased by 1.5 b.p.m. (-11.0, 13.5). All changes were statistically significant (P < 0.001). Two consecutive increases in blood pressure or pulse rate of >10 mmHg/b.p.m. were observed in 4.7 and 3.5% of subjects, respectively. Fifteen subjects (0.1%) died; 10 deaths were attributed to a cardiovascular cause, equivalent to 1.2 and 0.8 deaths per 100 years of exposure, respectively. CONCLUSION Six-week treatment with sibutramine appears to be efficacious, tolerable and safe in this high-risk population for whom sibutramine is usually contraindicated.
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Affiliation(s)
- Christian Torp-Pedersen
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen 2400 NV, Denmark.
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Gürsoy A, Erdoğan MF, Cin MO, Cesur M, Başkal N. Effect of Sibutramine on Blood Pressure in Patients with Obesity and Well-Controlled Hypertension or Normotension. Endocr Pract 2005; 11:308-12. [PMID: 16191490 DOI: 10.4158/ep.11.5.308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the short-term effects of sibu-tramine on blood pressure (BP) and heart rate (HR) in normotensive and controlled hypertensive obese patients by using ambulatory blood pressure monitoring (ABPM). METHODS Before and 5 to 7 days after the initiation of sibutramine treatment (10 mg or 15 mg daily), when steady-state concentrations of sibutramine had been reached, ABPM was performed in 81 obese patients. Of this overall study group, 47 patients (26 with normoten-sion and 21 with controlled hypertension) received sibu-tramine in a dosage of 10 mg/day, and 34 patients (18 with normotension and 16 with controlled hypertension) received sibutramine in a dosage of 15 mg/day. RESULTS Office-measured systolic and diastolic BPs in normotensive and controlled hypertensive groups of patients with obesity were not significantly different before and after treatment with both doses of sibutramine. ABPM results for normotensive obese groups showed that mean systolic and diastolic BPs were not significantly different after treatment with either 10-mg or 15-mg daily doses of sibutramine, in comparison with baseline. Similarly, in the controlled hypertensive obese groups, the ABPM results were not significantly different before and after sibutramine treatment. Moreover, the mean HR did not change significantly after versus before sibutramine treatment in both dosage groups. CONCLUSION Sibutramine did not induce or exacerbate hypertension and had no effect on HR in normotensive and controlled hypertensive obese patients when used in either of two suggested daily doses (10 mg or 15 mg).
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Affiliation(s)
- Alptekin Gürsoy
- Department of Endocrinology and Metabolic Diseases, Ankara University, School of Medicine, Ankara, Turkey
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Birkenfeld AL, Schroeder C, Pischon T, Tank J, Luft FC, Sharma AM, Jordan J. Paradoxical effect of sibutramine on autonomic cardiovascular regulation in obese hypertensive patients. Clin Auton Res 2005; 15:200-6. [PMID: 15944869 DOI: 10.1007/s10286-005-0270-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Accepted: 01/28/2005] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sibutramine, a serotonin and norepinephrine transporter blocker, is a common adjunctive obesity treatment. Acute studies in healthy subjects suggested that an inhibitory central nervous mechanism might attenuate the peripheral stimulatory effect on the sympathetic nervous system. This notion has not been tested in overweight and obese patients. METHODS We conducted a randomized, controlled clinical study in hypertensive patients with BMI > or = 27 to < 40 kg/m(2). After 4 week placebo run-in period patients were randomized to four different antihypertensive treatments or placebo. After 4 weeks of antihypertensive therapy, patients were additionally treated with sibutramine 15 mg o. d. for 3 months. Patients underwent cardiovascular autonomic reflex testing and a graded head-up tilt test at the end of each phase. RESULTS Mean body weight decreased from 98.5+/-4 to 94.7+/-4 kg (p<0.05) between end of placebo run-in and end of sibutramine treatment. Supine blood pressure was 154+/-3/80+/-2, 145+/-3/76+/-2 and 150+/-3/79+/-2mmHg at the end of placebo run-in, after antihypertensive titration (ns) and end of sibutramine treatment (ns), respectively. Blood pressure was affected similarly during head up tilt testing. The systolic blood pressure response to cold pressor testing was diminished with sibutramine (p<0.01). Sibutramine decreased low frequency systolic blood pressure oscillations in the supine position (p<0.01). CONCLUSIONS Resting blood pressure tends to increase with sibutramine, whereas blood pressure during sympathetic stimulation and low frequency blood pressure oscillations are decreased. These paradoxical changes are consistent with previous studies in healthy subjects and suggest a combination of peripheral and central nervous system mechanisms.
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Affiliation(s)
- Andreas L Birkenfeld
- Franz-Volhard Clinical Research Center, Medical Faculty of the Charité and Helios Klinikum, Berlin, Germany
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Filippatos TD, Kiortsis DN, Liberopoulos EN, Mikhailidis DP, Elisaf MS. A review of the metabolic effects of sibutramine. Curr Med Res Opin 2005; 21:457-68. [PMID: 15811215 DOI: 10.1185/030079905x38132] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Obesity is associated with an increased incidence of diabetes, hypertension, dyslipidaemia and coronary artery disease. Current management strategies of obesity include lifestyle management strategies of obesity include lifestyle interventions and pharmaco therapy. Sibutramine is a drug with established efficacy in weight reduction and maintenance of weight loss. It reduces food intake and attenuates the fall in reduces food intake and attenuates the fall in metabolic rate associated with weight loss. OBJECTIVE To review the metabolic effects associated with sibutramine use. METHODS Relevant articles were identified through a Medline search (up to December 2004). RESULTS Weight loss with sibutramine treatment is associated with improved insulin sensitivity and a fall in glycosylated haemoglobin levels in type 2 diabetic patients. In most trials sibutramine exerted favourable effects on lipids, especially exerted favourable effects on lipids, especially on high density lipoprotein (HDL) cholesterol and triglycerides, as well as on the total:HDL cholesterol ratio. Sibutramine also lowers serum uric acid concentrations. Furthermore, this drug seems to favourably influence adipocytokines; it reduces serum leptin and resistin levels and increases adiponectin levels. Sibutramine also exerts a beneficial effect on hyper androgenaemia in obese women with polycystic ovary syndrome. Preliminary findings also suggest that weight loss following treatment with sibutramine is useful in patients with non-alcoholic fatty liver disease (NAFLD). CONCLUSION Weight loss following sibutramine administration is associated with several favourable metabolic effects.
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Affiliation(s)
- T D Filippatos
- Department of Internal Medicine, Medical School, University of Ioannina, Greece
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Affiliation(s)
- Kyung-Hee Park
- Department of Family Medicine, Hallym University College of Medicine, Sacred Heart Hospital, Korea. ,
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