Sunday 22 November 2009, 12:00AM
Clinical question
How effective are weight-reducing drugs in hypertensive
patients?
Bottom line
Although trials of orlistat and sibutramine in patients with
elevated blood pressure demonstrated statistically significant
decreases in weight, orlistat reduced blood pressure and
sibutramine increased blood pressure.
Caveat
No long term mortality and morbidity RCT evidence is available
for these drugs. Trials of rimonabant in this patient population
could not be included.
Context
Orlistat, sibutramine and rimonabant are the main anti-obesity
drugs in current use. Orlistat and sibutramine have been approved
for long term treatment of obesity throughout much of the world.
Rimonabant was approved for use in the European Union in 2006, and
has also been approved in some South American and Asian countries.
Rimonabant does not have US Food and Drug Administration (FDA)
approval since preclinical and clinical data raised concerns about
associations between rimonabant and increased frequency of
psychiatric adverse events, including suicidality, an ill-defined
constellation of neurological signs and symptoms, and seizures.1 In
January 2009, the European Commission issued a decision to withdraw
market authorisation for rimonabant in all countries of the
European Union.2
Cochrane Systematic Review
Siebenhofer A et al. Long term effects of weight-reducing drugs
in hypertensive patients. Cochrane Reviews 2009, Issue 3. Article
No. CD007654. DOI: 10.1002/14651858.CD007654.pub2. This review
contains 8 studies involving 2726 participants.
Further references
- Food, Drug Administration. Egan AG. Colman EG.
www.fda.gov/ohrms/dockets/AC/07/briefing/2007-4306b1fda-backgrounder.pdf
- European Medicines Agency.
www.emea.europa.eu/humandocs/PDFs/EPAR/acomplia/3945709en.pdf