EDITORIAL [Pharmacological Treatments for Obesity and Obesity-Hypertension (Guest Editor: Kazuko Masuo)]

Obesity, hypertension and obesity-related hypertension are growing health problems. Hypertension is an important risk factor for cardiovascular disease (CVD), particularly in patients with obesity, diabetes, metabolic disease, or end-organ damage. Obese subjects are frequently associated with diabetes, metabolic disease, and end-organ damage (i.e. end-stage renal damage). An integrated cardiovascular risk management approach is being adopted: aggressive blood pressure (BP) control is important in patients with high CVD risk, and well-tolerated antihypertensive agents with protective benefits beyond BP lowering are advantageous. The identification and management of these risk factors is an important part of the overall management of hypertensive patients. Because obese hypertensive patients are more predisposed to target organ damage, stringent targets for blood pressure control have been set in clinical guidelines, however clinical trial and real-life evidence suggest that these targets are difficult to achieve. In order to attain optimally reduction in the risk for cardiovascular events in patients with obesity-related hypertension, optimal blood pressure control along with comprehensive lifestyle modification for weight loss is required. The most important and difficult aspect in controlling obesity, however, is avoiding weight regain. Anti-obesity pharmacological treatments may help to lose weight and maintain weight loss. It is widely recognized that stimulation of the renin-angiotensin system (RAS), heightened sympathetic nerve activity and insulin resistance (or hyperinsulinemia) relate to obesity-related hypertension. Recently, many clinical and epidemiological studies have shown that angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) are highly efficacious, persistent, well-tolerated antihypertensive agents, with additional benefits in obesity-related hypertension, cardiovascular pathogenesis, end-organ damage, and in diabetes, or metabolic syndrome due to those cardio- and renalprotective effects. Most patients with obesity-related hypertension are very resistant to the control of hypertension and frequently require two or more types of medications to achieve their BP goals. Therefore, other antihypertensive drug classes, such as the centrally acting imidazolin receptor agonists, which inhibit sympathetic overflow from the brain, and calcium channel blockers, are frequently used to control resistant hypertension. The purpose of this article is to provide the current findings on pharmacological anti-obesity treatments and antihypertensive treatments in obesity, obesity-related hypertension.