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Consider Weight When Choosing Blood Pressure Meds: Study
Date:12/6/2012

a diuretic and Lotensin (benazepril), which is known as an ACE inhibitor, with a regimen of Lotensin plus the calcium channel blocker Norvasc.

The goal of the study was to see which combination better controlled high blood pressure in people at high risk for heart disease and to see if weight had an effect on blood pressure control.

Participants were grouped into three categories -- normal weight, overweight and obese -- based on their body mass index (BMI). BMI is a body fat calculation based on height and weight.

Normal-weight people taking the diuretic fared the worst, the investigators found. This group was 68 percent more likely to have a heart attack, stroke or die than obese patients taking a diuretic.

People taking the Lotensin-Norvasc combination did well regardless of weight, they found. This drug duo reduced stroke, heart attack and death by 43 percent in normal-weight people and 24 percent in overweight people, according to the study.

Among obese people, both drug regimens worked well with no significant differences between them, the researchers found.

However, some doctors argue against giving obese patients diuretics.

"We disagree that diuretics are a reasonable choice for the obese patient," said Dr. Franz Messerli, a cardiologist and director of the hypertension program at St. Luke's-Roosevelt Hospital and Columbia University College of Physicians and Surgeons in New York City.

Obesity is a reason not to use diuretics, he said. Diuretics should be used only when certain types of heart disease, including heart failure, exist, said Messerli, co-author of an accompanying journal editorial.

In obese patients, diuretics can trigger poor blood sugar control and gout, Messerli said.

Messerli agreed that calcium channel blockers should be first-line treatment for all patients with high blood pressure whether they are fat, thin or in between.

Dr. Gregg Fonarow, a spokesman for the A
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