ACE Inhibitors and ARBs for Obesity-Related Hypertension

Multiple abnormalities in hemodynamics, endocrine factors and adipocytokines are involved in pressor mechanisms of obesity-related hypertension. These abnormalities induce insulin resistance, which plays a central role in the mechanism leading to blood pressure elevation. Thus, in addition to body weight control, selection of pharmacological agents that improve insulin resistance is important for treatment of patients with obesity and hypertension. Although angiotensin receptor antagonists (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), α-adrenoceptor blockers, and Ca2+-channel antagonists have been shown to improve insulin sensitivity in hypertensives, ARBs and ACEIs are mainly selected for this purpose. Beneficial effects of ARBs in obesity-related hypertension have recently been confirmed in Japanese subjects by the CASE-J trial.