Does it matter how blood pressure is lowered in patients with metabolic risk factors?

Association between waist-to-hip ratio and risk of myocardial infarction according to BMI in a study of risk factors for first myocardial infarction in 52 countries and over 27,000 subjects (INTERHEART). Vertical bars indicate 95% CIs. BMI, body mass index; CI, confidence intervals; OR, odds ratio. Reprinted with permission from Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet 2005;366:1640–49.¹¹

Factors contributing to cardiovascular risk in patients with visceral adiposity. Apo-B, apolipoprotein B; C, cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; PAI-1, plasminogen activator inhibitor-1. Reproduced with permission from Sharma AM. Adipose tissue: a mediator of cardiovascular risk. Int J Obes 2002;26:S5–7.¹²

Effect of weight loss on circulating components of the RAS in 17 obese women. Results are presented as means ± standard deviation. *P < .05. Note: the glucose curves before and after amlodipine treatment were exactly similar and overlapped. ACE, angiotensin-converting enzyme; AGT, angiotensinogen; Ang II, angiotensin II; RAS, renin-angiotensin system. Reproduced with permission from Engeli S, Böhnke J, Gorzelniak K, Janke J, Schling P, Bader M, et al. Weight loss and the renin-angiotensin-aldosterone system. Hypertension 2005;45:356–62.²⁷

Changes in glucose tolerance following a 75-g oral glucose load in Japanese patients with metabolic syndrome and abdominal obesity treated with telmisartan, 20 to 40 mg, or amlodipine, 2.5 to 5 mg, for 6 months. Results are presented as means ± standard deviation. Reproduced with permission from Shimabukuro M, Tanaka H, Shimabukuro T. Effects of telmisartan on fat distribution in individuals with the metabolic syndrome. J Hypertens 2007;25:841–48.³⁴

VFA in Japanese patients with metabolic syndrome and abdominal obesity treated with telmisartan, 20 to 40 mg, or amlodipine, 2.5 to 5 mg, for 6 months. VFA, visceral fat area. Reproduced with permission from Shimabukuro M, Tanaka H, Shimabukuro T. Effects of telmisartan on fat distribution in individuals with the metabolic syndrome. J Hypertens 2007;25:841–48.³⁴