Impact of visceral fat on blood pressure and insulin sensitivity in hypertensive obese women.

OBJECTIVE: The relationship among body fat distribution, blood pressure, serum leptin levels, and insulin resistance was investigated in hypertensive obese women with central distribution of fat. RESEARCH METHODS AND PROCEDURES: We studied 74 hypertensive women (age, 49.8 +/- 7.5 years; body mass index, 39.1 +/- 5.5 kg/m(2); waist-to-hip ratio, 0.96 +/- 0.08). All patients were submitted to 24-hour blood pressure ambulatory monitoring (24h-ABPM). Abdominal ultrasonography was used to estimate the amount of visceral fat (VF). Fasting blood samples were obtained for serum leptin and insulin determinations. Insulin resistance was estimated by homeostasis model assessment insulin resistance index (HOMA-r index). RESULTS: Sixty-four percent of the women were postmenopausal, and all patients showed central distribution of fat (waist-to-hip ratio > 0.85). The VF correlated with systolic 24h-ABPM values (r = 0.28, p = 0.01) and with HOMA-r index (r = 0.27; p = 0.01). VF measurement (7.5 +/- 2.3 vs. 5.9 +/- 2.2 cm, p < 0.001) and the systolic 24h-ABPM (133 +/- 14.5 vs. 126 +/- 9.8 mm Hg, p = 0.04), but not HOMA-r index, were significantly higher in the postmenopausal group (n = 48) than in the premenopausal group (n = 26). No correlations were observed between blood pressure levels and HOMA-r index, leptin, or insulin levels. In the multiple regression analysis, visceral fat, but not age, body fat mass, or HOMA-r index, correlated with the 24h-ABPM (p = 0.003). DISCUSSION: In centrally obese hypertensive women, the accumulation of VF, more often after menopause, is associated with higher levels of blood pressure and insulin resistance. The mechanism through which VF contributes to higher blood pressure levels seems to be independent of leptin or insulin levels.

Effects of sibutramine on the treatment of obesity in patients with arterial hypertension.

OBJECTIVE: To assess the effects of weight reduction with 10mg of sibutramine or placebo on blood pressure during 24 hours (ambulatory blood pressure monitoring), on left ventricular mass, and on antihypertensive therapy in 86 obese and hypertensive patients for 6 months. METHODS: The patients underwent echocardiography, ambulatory blood pressure monitoring, and measurement of the levels of hepatic enzymes prior to and after treatment with sibutramine or placebo. RESULTS: The group using sibutramine had a greater weight loss than that using placebo (6.7% versus 2.5%; p<0.001), an increase in heart rate (78.3 +/- 7.3 to 82 +/- 7.9 bpm; p=0.02), and a reduction in the left ventricular mass/height index (105 +/- 29.3 versus 96.6 +/- 28.58 g/m; p=0.002). Both groups showed similar increases in the levels of alkaline phosphatase and comparable adjustments in antihypertensive therapy; blood pressure, however, did not change. CONCLUSION: The use of sibutramine caused weight loss and a reduction in left ventricular mass in obese and hypertensive patients with no interference with blood pressure or with antihypertensive therapy.

Efeitos da sibutramina no tratamento da obesidade em pacientes com hipertensão arterial / Effects of sibutramine on the treatment of obesity in patients with arterial hypertension

OBJECTIVE: To assess the effects of weight reduction with 10mg of sibutramine or placebo on blood pressure during 24 hours (ambulatory blood pressure monitoring), on left ventricular mass, and on antihypertensive therapy in 86 obese and hypertensive patients for 6 months. METHODS: The patients underwent echocardiography, ambulatory blood pressure monitoring, and measurement of the levels of hepatic enzymes prior to and after treatment with sibutramine or placebo. RESULTS: The group using sibutramine had a greater weight loss than that using placebo (6.7 percent versus 2.5 percent; p<0.001), an increase in heart rate (78.3±7.3 to 82±7.9 bpm; p=0.02), and a reduction in the left ventricular mass/height index (105±29.3 versus 96.6±28.58 g/m; p=0.002). Both groups showed similar increases in the levels of alkaline phosphatase and comparable adjustments in antihypertensive therapy; blood pressure, however, did not change. CONCLUSION: The use of sibutramine caused weight loss and a reduction in left ventricular mass in obese and hypertensive patients with no interference with blood pressure or with antihypertensive therapy

Efeito da sibutramina sobre o perfil da pressäo arterial nas 24 horas e sobre os parâmetros metabólicos que caracterizam a síndrome de resistência à insulina em pacientes obesos e hipertensos / Effects of subutramine therapy on 24 hour blood pressure profile and the metabolic parameters of the insulin resistence syndrome on hypertensive obese patients

Objetivo: Avaliar os efeitos da reduçao de peso com sibutramina (S) 10 mg ou placebo (PI) por seis meses sobre o perfil da pressao arterial nas 24 horas, sobre a massa ventricular esquerda (MVE) e a terapia anti-hipertensiva (TAH) em 86 pacientes obesos e hipertensos. Métodos: Antes e após o tratamento com S ou PI associada', à dieta hipocalórica os' pacientes foram' submetidos ao ecocardiograma à monitorizaçao da pressao arterial nas 24 horas e às determinaçoes dos níveis das enzimas hepáticas Resultados 0 grupo S apresentou perda ponderal maior que o PI (6,7 por cento vs 2,5 por cento; p<0,001). Aumentos na freqüência cardíaca, de 78 7,3 para 82 ñ 7,9 bpm (p=0,02) e reduçoes na MVE/Altura, de 105 29,3 para 97 ñ 28,6 g/m (p=0,002) foram observados apenas no grupo S Nos dois grupos ocorreram aumentos semelhantes nos níveis da fosfatase alcalina e ajustes comparáveis na TAH, enquanto a pressao arterial nao mostrou alteraçoes. Conclusao: Em pacientes obesos e hipertensos sibutramina associada à dieta hipocalórica promoveu perda ponderal mais acentuada que o placebo, e reduçao da massa do ventrículo esquerdo, serr interferir na pressao arterial e no tratamento antihipertensivo

Obesidade: condiçäo prejudicial à saúde / Obesity: harmful condition to individual healt

Os resultados dos estudos epidemiológicos obtidos na última década apontam a obesidade como condiçäo que predispöe a maior morbidade e mortalidade. A prevalência da obesidade vem aumentando em praticamente todo o mundo. No Brasil, aumentou, entre 1975 e 1997, no nordeste e nas faixas da populaçäo de menor poder aquisitivo. A mortalidade condicionada pela obesidade advém, principalmente, da maior ocorrência de eventos cardiovasculares. A obesidade associa-se a fatores de risco coronariano. Aumentos na freqüência de câncer de cólon, reto e próstata tem sido observados em homens, enquanto a obesidade em mulheres se associa a maior frequência de câncer de vesícula, endométrio e mamas. Além disso, a obesidade predispöe a colelitíase, esteatose hepática, osteoartrite, osteoartrose, apnéia obstrutiva do sono, alteraçöes da ventilaçäo pulmonar, alteraçöes dos ciclos menstruais e reduçäo da fertilidade, condiçöes que experimentam melhora com a reduçäo de peso. Reduçäo de peso da ordem de 5 a 10 porcento é medida efetiva no sentido de combater as condiçöes mórbidas que aumentam o risco cardiovascular.(au)