Aggressive BP treatment more beneficial for obese patients

The clinical benefit of intensive blood pressure (BP) lowering in patients with established coronary artery disease becomes increasingly important in obese patients, according to study results reported during the American Academy of Cardiology's 56th annual scientific session.

"Blood pressure elevation is known to increase coronary heart disease risk and blood pressure is poorly controlled among obese patients. Obesity is also associated with increased atherosclerosis. Yet, there are no specific treatment recommendations for hypertension in obese patients," said Sanjeey P. Bhavnani, MD, from the University of Connecticut, Hartford.

He conducted a subanalysis of obese patients who participated in the Comparison of Amlodipine versus Enalapril to Limit Occurrence of Thrombosis (CAMELOT) trial. CAMELOT included 903 patients with a body mass index (BMI) of 30 g/m² or greater. The average patient age was 58.4 years, 25.1% had diabetes, and 68.2% had hypertension.

Patients were randomized to one of the two drug treatment groups or to placebo for 2 years. The primary study endpoints were cardiovascular events, hospitalization for angina, revascularization, and nonfatal myocardial infarction (MI).

Obese patients with aggressive blood pressure lowering had a 16.6% lower rate of cardiovascular events compared to those taking placebo. Hospitalizations for angina occurred in 7.8% of treated patient versus 12.5% of those in the placebo group, revascularization procedures were performed in 10.1% and 17.2%, respectively, and nonfatal MI occurred in 1% and 3.4%, respectively.

When compared with patient groups with a BMI within normal range, aggressively treated obese patients had higher rates of total cardiovascular events and hospitalizations for angina hospitalizations, whereas revascularization procedures and nonfatal MI were more frequent among the normal BMI patients than the obese.

Dr. Bhavnani said that the aggressively treated obese patients had lower rates of all outcomes measures compared with the aggressively treated patients with below average BMI.