Effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension

Background Obesity is associated with hypertension, but the exact mechanism is not fully understood. Bariatric surgery significantly decreases weight and blood pressure (BP). Low plasma nitric oxide (NO) and raised asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO, concentrations are associated with both obesity and hypertension. Correlations between the changes in these parameters were studied after bariatric surgery. Methods Weight, BP, plasma ADMA and NO were measured in 29 obese patients (24 female, 5 male) before and six weeks after bariatric surgery. Results Patients were 39.2 ± 1.2 (mean ± SEM) years old and weighed 126 ± 3 kg. Six weeks after the surgery, patients had lost 10 ± 0.7 kg ( P < 0.0001) and mean arterial pressure (MAP) decreased by 11 ± 1.0 mmHg ( P < 0.0001). The plasma ADMA concentration decreased by 24 ± 2% from 5 ± 0.4 to 4.0 ± 0.3 μmol/L ( P < 0.0001). The plasma total nitrite concentration increased by 15 ± 1% from 51.4 ± 2.6 to 60 ± 3 μmol/L ( P < 0.0001). The correlation between the decrease of ADMA and increase of NO subsequent to weight loss was significant ( P < 0.0001). However, MAP was not correlated to the changes in ADMA or NO. Conclusions After bariatric surgery, beneficial changes in BP, NO and ADMA occur, but our findings suggest that these BP changes are independent of changes in the NO–ADMA axis. Other causes for the changes in BP should therefore be considered.

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P4414Effects of lorcaserin on the cardiometabolic risk factors in overweight or obese patients: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0817 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H H Kuo ◽

M E Liu ◽

P L Lin ◽

L.Y.-M Liu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Meta Analysis ◽

Obese Patients ◽

Serotonin 2C Receptor ◽

Randomized Controlled Clinical Trials ◽

Randomized Controlled ◽

Search Terms

Abstract Introduction Lorcaserin is a selective serotonin 2c receptor agonist approved as an anti-obesity agent. The additional cardiometabolic benefits associated with lorcaserin have not been conclusively established. Purpose To examine the effects of lorcaserin on blood pressure, heart rate and other metabolic parameters in overweight or obese patients from randomized controlled clinical trials (RCTs). Methods A literature search was conducted on PubMed, EMBASE, and Cochrane Central using search terms: “lorcaserin”, “Belviq”, and “randomized controlled trials” without language restrictions. RCTs with a follow-up period of at least 24 weeks were included for the meta-analysis. Results Five studies with 9349 patients in the lorcaserin group and 9370 patients in the placebo group were included. Compared with placebo, lorcaserin not only reduced weight (mean difference [MD] = −3.03 kg, 95% CI: −3.42, −2.63, P<0.ehz745.08171, I2 =68%), waist circumference (MD=−2.27 cm, 95% CI: −2.71, −1.83, P<0.ehz745.08171, I2=57%) and BMI (MD=−1.11 kg/m2, 95% CI: −1.27, −0.96, P<0.ehz745.08171, I2=68%), but also improved SBP (MD=−0.75 mmHg, 95% CI: −1.12, −0.38, P<0.0001, I2=0%), DBP (MD=−0.70 mmHg, 95% CI: −0.93, −0.48, P<0.ehz745.08171, I2=0%), heart rate (MD=−0.94 bpm, 95% CI: −1.28, −0.60, P<0.ehz745.08171, I2=0%), LDL (MD=−1.47 mg/dL, 95% CI: −2.21, −0.74, P<0.0001, I2=0%), HDL (MD=0.55 mg/dL, 95% CI: 0.08, 1.01, P=0.02, I2=18%), triglycerides (MD=−8.71 mg/dL, 95% CI: −12.14, −5.28, P<0.ehz745.08171, I2=71%), and fasting plasma glucose (MD=−5.69 mg/L, 95% CI: −9.5, −1.87, P=0.003, I2=93%). Our findings support that lorcaserin has consistent and favourable effects on blood pressure, heart rate, and all criteria of metabolic syndrome. Summary of lorcaserin effects Conclusion Lorcaserin improved all cardiometabolic parameters modestly in addition to its weight loss effect in overweight or obese patients. More research is needed to determine its long-term cardiovascular benefits.

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Including Mixed Tree Nut Snacks in a Weight Loss and Weight Maintenance Intervention Resulted in Weight Loss and Increased Satiety

Current Developments in Nutrition ◽

10.1093/cdn/nzab037_030 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 320-320

Author(s):

Susanne Henning ◽

Jing Wang ◽

Sijia Wang ◽

Tianyu Qin ◽

Yajing Pan ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Weight Loss ◽

Oleic Acid ◽

Diastolic Blood Pressure ◽

Weight Maintenance ◽

Tree Nuts ◽

Weight Loss Diet ◽

Tree Nut ◽

Maintenance Program

Abstract Objectives Tree nuts are an excellent dietary source of protein and healthy fat leading to increased satiety. Tree nuts also provide polyphenols, vitamins and minerals supporting the immune response. However, there is a concern that tree nuts are not suitable to be included in a weight loss diet due to their fat content. Therefore, it was the objective of the study to test whether including mixed tree nuts in a weight loss and maintenance program will lead to weight loss by increasing satiety and decreasing inflammation. Methods We performed a randomized, controlled, two-arm study in 95 overweight individuals consuming 1.5 oz of mixed tree nuts daily (n = 56) or equal amount of calories in the form of a pretzel snack (n = 39) as part of a hypocaloric weight loss diet (−500 calories of resting metabolic rate) for 12 wks followed by an isocaloric weight maintenance program for an additional 12 wks. Results The dropout rate was significantly lower in the tree nut (16.4%) compared to the pretzel (35.9%) group. Participants experienced significant weight loss (12 wks: −1.6 and −1.9 and 24 wks: −1.5 kg and −1.4 kg) in the tree nut and pretzel group, respectively, without difference between groups at any time point. In addition, both groups showed a significant decrease in diastolic blood pressure at 12 wks and a significant increase in satiety at 24 wks, but only participants in the mixed tree nut group showed significant decrease in heart rate at 4, 12 and 24 wks. Plasma oleic acid concentration was significantly increased at 12 and 24 wks in the tree nut group, while in the pretzel group plasma oleic acid was significantly increased and stearic acid decreased at 12 wks and linolenic acid was increased at 24 wks. No change in fasting plasma triglyceride, total cholesterol and HDL-cholesterol was observed in both groups. No change in inflammatory markers except plasma MCP-1 was decreased significantly in the tree nut group at 4 wks. Conclusions In summary, including mixed tree nuts in a weight loss and maintenance diet can maintain compliance and promote weight loss similar to standard weight loss and maintenance diets. Although both, the mixed tree nut diet and pretzel diet resulted in decreased diastolic blood pressure, only consumption of the mixed tree nut diet led to significantly decreased heart rate and increased study retention. Funding Sources International Tree Nut Council.

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Effects of Intermittent Compared With Continuous Energy Restriction on Blood Pressure Control in Overweight and Obese Patients With Hypertension

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.750714 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chao-Jie He ◽

Ye-Ping Fei ◽

Chun-Yan Zhu ◽

Ming Yao ◽

Gang Qian ◽

...

Keyword(s):

Blood Pressure ◽

Weight Loss ◽

Body Composition ◽

Systolic Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Energy Restriction ◽

Obese Patients ◽

Continuous Energy ◽

The Mean

Background and Aims: Weight-loss diets reduce body weight and improve blood pressure control in hypertensive patients. Intermittent energy restriction (IER) is an alternative to continuous energy restriction (CER) for weight reduction. We aimed to compare the effects of IER with those of CER on blood pressure control and weight loss in overweight and obese patients with hypertension during a 6-month period.Methods: Two hundred and five overweight or obese participants (BMI 28.7 kg/m2) with hypertension were randomized to IER (5:2 diet, a very-low-calorie diet for 2 days per week, 500 kcal/day for women and 600 kcal/day for men, along with 5 days of a habitual diet) compared to a moderate CER diet (1,000 kcal/day for women and 1,200 kcal/day for men) for 6 months. The primary outcomes of this study were changes in blood pressure and weight, and the secondary outcomes were changes in body composition, glycosylated hemoglobin A1c (HbA1c), and blood lipids.Results: Of the 205 randomized participants (118 women and 87 men; mean [SD] age, 50.2 [8.9] years; mean [SD] body mass index, 28.7 [2.6]; mean [SD] systolic blood pressure, 143 [10] mmHg; and mean [SD] diastolic blood pressure, 91 [9] mmHg), 173 completed the study. The intention-to-treat analysis demonstrated that IER and CER are equally effective for weight loss and blood pressure control: the mean (SEM) weight change with IER was −7.0 [0.6] kg vs. −6.8 [0.6] kg with CER, the mean (SEM) systolic blood pressure with IER was −7 [0.7] mmHg vs. −7 [0.6] mmHg with CER, and the mean (SEM) diastolic blood pressure with IER was −6 [0.5] mmHg vs. −5 [0.5] mmHg with CER, (diet by time P = 0.62, 0.39, and 0.41, respectively). There were favorable improvements in body composition, HbA1c, and blood lipid levels, with no differences between groups. Effects did not differ according to completer analysis. No severe hypoglycemia occurred in either group during the trial.Conclusions: Intermittent energy restriction is an effective alternative diet strategy for weight loss and blood pressure control and is comparable to CER in overweight and obese patients with hypertension.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000040468.

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Comparison of the effects of liraglutide and sibutramine in obese patients

Obesity and metabolism ◽

10.14341/omet12498 ◽

2021 ◽

Vol 18 (2) ◽

pp. 218-228

Author(s):

G. A. Matveev ◽

T. I. Golikova ◽

A. A. Vasileva ◽

E. V. Vasilieva ◽

A. Y. Babenko ◽

...

Keyword(s):

Oxidative Stress ◽

Blood Pressure ◽

Weight Loss ◽

Side Effects ◽

Blood Pressure Level ◽

Density Lipoprotein ◽

Regulation System ◽

Positive Trend ◽

Obese Patients ◽

Markers Of Inflammation

Background: Obesity is a global noncommunicable pandemic. The low effectiveness of treating obesity is associated with the difficulty of maintaining weight loss due to the reaction of the appetite regulation system. Drugs with central mechanisms of action can help overcome this problem.Aim: The aim of our study was to compare the effects of liraglutide and sibutramine (Reduxin) on the dynamics of weight and cardiometabolic parameters in obese patients without cardiovascular diseases.Materials and methods: We estimated the dynamics of the main metabolic parameters (BMI, glucose, lipid metabolism, blood pressure), the level of hormones involved in the regulation of fat metabolism (leptin, adiponectin, insulin), the HOMA-IR index, markers of oxidative stress and inflammation during therapy with liraglutide in comparison with reduxin for 6 months in obese patients.Results: 64 obese patients were included in the study: 25 patients — in the “Liraglutide” group, 39 patients — in the “Sibutramine” group in accordance with the declared inclusion / exclusion criteria. The included patients were young, average body mass index (BMI) (37.92 ± 5.45 kg / m2), average glycemic level was 5.47 ± 0.81 mmol /l, HOMA-IR was 6.01 ± 4.25, blood pressure was at inclusion was within the normal range, but 21.8% of patients received antihypertensive therapy.Both treatment options provided a comparable decrease in body weight (-10.28% vs -9.47%, p = 0.13)., Leptin level (-32.12% vs -41.77%, p = 0.77) and myeloperoxidase (-33.33% vs -19.91%, p = 0.2). The blood pressure level did not change significantly on liraglutide, while on reduxin the level of diastolic blood pressure (dBP) increased significantly (6.87%, p = 0.006). There was a more pronounced decrease in insulin levels compared to the baseline level (-46%, p = 0.005), as well as a decrease in the HOMA-IR index (-50.08, p = 0.005) on liraglutide therapy.An increase in adiponectin levels (+ 45.36% vs 14.01%, p = 0.0045) and a decrease in low density lipoprotein(LDL) cholesterol were significantly more pronounced on reduxin therapy (-15.03% vs -9.4%, p = 0.006).36% of the participants completed their participation in the study ahead of schedule due to the lack of effect in the form of weight loss in the «Liraglutide» group. Side effects in the “Liraglutide” group were observed in 16% of patients. 48% of patients took part in the study within 6 months. In the «Sibutramine» group 33.4% of patients completed the study ahead of schedule for reasons unrelated to the drug intake, the side effects were observed in 20.5% of patients. 46.1% of participants in the «Sibutramine» group received therapy for 6 months.Conclusions: This study confirms the previous findings that both liraglutide and reduxin therapy provide effective weight loss. We found a positive trend in markers of inflammation, atherogenesis and oxidative stress, and leptin levels. Liraglutide therapy was accompanied by a more pronounced effect on the state of carbohydrate metabolism, and reduxin therapy provided a more pronounced dynamics of lipid disorders and adiponexin. Both groups were characterized by a rather low adherence to therapy, but the incidence of side effects requiring stopping therapy was higher in the Sibutramine group.

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Therapy of obesity by sibutramin: polymorphisms of TPH2 and GNB3 genes and decrease of body weight

Obesity and metabolism ◽

10.14341/omet9646 ◽

2018 ◽

Vol 15 (2) ◽

pp. 40-45

Author(s):

Marina O. Galieva ◽

Ekaterina A. Troshina ◽

Nataliya V. Mazurina ◽

Anna P. Volynkina ◽

Andrey V. Artiushin ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Weight Loss ◽

Body Weight ◽

Genetic Factors ◽

Research Study ◽

Body Weight Loss ◽

The Body ◽

Tph2 Gene

Aims. To study of the polymorphisms of the TPN2 and GNB3 genes in obese patients and their effect on weight loss in patients on sibutramine therapy. Materials and methods. The research study included 118 patients with exogenous-constitutional obesity who received Reduxin (sibutramine + CMC) at the dose of 10 mg. Term follow-up was 3 months. A genetic study was performed to assess ТРН2 and GNB3 gene polymorphisms. The response to the therapy was evaluated after 3 months by the dynamics of body weight. Results. In the study the G703T polymorphism of the GNB3 gene showed that during 3 months of observation, carriers of the TT genotype had a greater decrease in body weight in comparison with carriers of the allele C -8 kg (-12; -5) vs. -5 kg (-8; -3), p = 0.018. In carriers of different variants of the genotype of the TPH2 gene (polymorphism C825T), there was no difference in body weight dynamics with sibutramine therapy. There was no correlation between the foresaid polymorphisms of the TPH2 and GNB3 genes with the indices of blood pressure and heart rate. Conclusions. 1. The result of sibutramin therapy may depend on genetic factors: in carriers of the TT-genotype C825T of the GNB3 gene the body weight loss was higher than among the carriers of the C allele. 2. Changes in blood pressure and heart rate did not show any statistically significant relationship with polymorphisms of the TPH2 and GNB3 genes.

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Weight Loss, Improved Body Composition and Fat Distribution by Tesomet in Acquired Hypothalamic Obesity

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.130 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A64-A65

Author(s):

Kim D Huynh ◽

Marianne C Klose ◽

Kim Krogsgaard ◽

Jorgen Drejer ◽

Sarah Byberg ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Weight Loss ◽

Body Composition ◽

Body Weight ◽

Adverse Events ◽

Qt Interval ◽

Dry Mouth ◽

Hypothalamic Obesity ◽

Corrected Qt Interval

Abstract Background: Structural damage to the hypothalamus often results in hypothalamic obesity characterized by rapid and severe weight-gain with increased risk of cardiovascular and metabolic morbidity and mortality. Currently, there are no approved or effective pharmacological treatments and conventional weight management remains largely ineffective. Objective: This RCT investigated safety and efficacy of Tesomet (co-administration of 0.5mg tesofensine and 50mg metoprolol) in hypopituitary patients with acquired hypothalamic obesity. Methods: Twenty-one (16 females) hypopituitary adults with hypothalamic obesity were randomized to Tesomet or placebo (2:1) for 24 weeks (NCT03845075). Subjects also received diet and lifestyle counselling. Primary endpoint was safety evaluated by change in heart rate, blood pressure and adverse events. Secondary endpoints included changes in anthropometric measures, body composition, corrected QT-interval and arrythmias. Results: Subjects had a median (range) age of 50 (25; 70) years and 90% had a BMI ≥30 kg/m2. Almost half (48%) had a history of craniopharyngioma, 86% had undergone pituitary/hypothalamic surgery, and 52% had irradiation therapy. All received one or more anterior pituitary hormone replacements; 52% had diabetes insipidus. In total, 18/21 subjects completed the study, one without investigational treatment. Three serious adverse events (SAE) were recorded in 2 subjects randomized to Tesomet. Adverse events were otherwise mostly mild (58%), frequently reported were sleep disturbances (62%), dry mouth (46%) and dizziness (46%), known side effects of tesofensine or metoprolol. Four subjects, two in each group, discontinued treatment. Tesomet discontinuation was secondary to anxiety (n=1) or dry mouth (n=1). No significant differences in heart rate or blood pressure were observed between the two groups. At week 24, compared to placebo (weight-loss: -0.3%), Tesomet treatment resulted in additional mean weight-loss of -6.3% (95CI [-11.3%; -1.3%], p=0.017); increase in the proportion of patients achieving >5% reduction in body weight (Tesomet 8; Placebo 1, OR 11.2 [1.0; 120.4], p=0.046); and reduction in waist circumference of -5.7cm ([-11.5; 0.1], p=0.054). Tesomet-induced weight loss was primarily correlated to a reduction in mean (SD) fat mass -5.3kg (5.3) (r2=0.9, P=0001) and to lesser extent a reduction in lean tissue mass -2.9kg (1.9) (r2=0.4, P=0.03). Treatment did not affect corrected QT-interval; mean change from placebo was -1.1ms (95CI [-16.0; 13.9], p=0.882), nor were arrythmias registered during the trial period. Conclusions: Tesomet was generally well-tolerated, did not affect heart rate, blood pressure or QTc-interval, and resulted in significant reductions in body weight compared to placebo in this cohort of hypopituitary patients with acquired hypothalamic obesity. The study was sponsored by Saniona A/S

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Abstract 16319: Large Weight Loss Improves Left Ventricular Geometry but Not Myocardial Function 6 Months After Bariatric Surgery (the Fatwest Study)

Circulation ◽

10.1161/circ.142.suppl_3.16319 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Lisa M Grymyr ◽

Saied Nadirpour ◽

Eva Gerdts ◽

Johannes Hjertaas ◽

Bjørn Nedrebø ◽

...

Keyword(s):

Bariatric Surgery ◽

Heart Rate ◽

Weight Loss ◽

Systolic Function ◽

Wall Stress ◽

Left Ventricular ◽

Obese Patients ◽

Large Weight Loss ◽

Lv Mass ◽

Severely Obese

Background: Bariatric surgery causes rapid and large weight loss and improves cardiovascular risk profile, yet the effect on left ventricular (LV) systolic function has been less explored. Methods: In the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study 98 severely obese patients (44±10 years, 72% women, preoperative body mass index [BMI] 41.8±4.8 kg/m 2 , 36% with hypertension) underwent echocardiography before and 5.9 months after gastric bypass surgery. We assessed changes in LV geometry and systolic function by biplane ejection fraction (EF), midwall shortening (MWS) and mitral annular systolic velocity (s′). LV hypertrophy was defined based on LV mass/height 2.7 . Myocardial O 2 demand was derived from the LV mass-wall stress-heart rate product. Results: Patients experienced on average a 10 kg/m 2 reduction in BMI, and a significant drop in heart rate and blood pressure (all p<0.001). LV mass (-12 g) and myocardial O 2 demand improved significantly (all p<0.01). However, LV EF (60 vs. 61%), s’ (8.5 vs. 8.3cm/s) and MWS (16.1 vs. 15.7%) remained unchanged, and 45% of patients had low MWS 6 months after surgery (Figure). In multivariable regression analyses, LV mass reduction was predicted by weight loss and female sex, independent of changes in blood pressure and heart rate (R 2 0.24, p <0.001) while lower myocardial O2 demand was explained by improvement in its three components, particularly lower LV end-systolic wall stress (R 2 0.9, p<0.001). Conclusion: In severely obese patients with normal EF, bariatric surgery induces a significant reduction in BMI, LV mass and myocardial O 2 demand, but no improvement in LV myocardial systolic function 6 months after surgery.

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