The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity

Abstract

Introduction: One in three US adults is living with obesity or hypertension, and more than 75% of hypertensive individuals are using antihypertensive medications. Therefore, it is important to examine blood pressure (BP) differences in populations that are using these medications with differing obesity status.

Aim: We examined whether BP attained when using various antihypertensive medications varies amongst different body mass index (BMI) categories and whether antihypertensive medication use is associated with differences in other metabolic risk factors, independent of BMI.

Methods: Adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 were used (n=15,285). Linear regression analyses were used to examine the main effects and interaction between antihypertensive use and BMI.

Results: In general, users of antihypertensive medications had lower BP than those not taking BP medications (NoBPMed) (P < 0.05), whereby in women, the differences in systolic BP between angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) users and NoBPMed were greater in those with obesity (ACE inhibitors: -14 ± 1 mmHg; ARB: -16 ± 1 mmHg) compared to normal weight individuals (ACE inhibitors: -9 ± 1 mmHg; ARB: -11 ± 1 mmHg) (P < 0.05). Diastolic BP differences between women ARB users and NoBPMed were also greatest in obesity (-5 ± 1 mmHg) (P < 0.05) whilst there were no differences in normal weight individuals (-1 ± 1 mmHg) (P>0.05). Furthermore, glucose levels and waist circumference in women were higher in those using ACE inhibitors compared to diuretics (P < 0.05).

Conclusion: ACE inhibitors and ARBs may be associated with more beneficial BP profiles in women with obesity, with no obesity-related BP differences for antihypertensive medication in men. However, there could be potential cardiometabolic effects for some antihypertensive medications that should be explored further.

Figure 1

Mean systolic and diastolic blood pressures (mmHg) among hypertensive adults using (a) β-blockers, (b) diuretics, (c) CCBs, and (d) other antihypertensive drugs by BMI category. Sample includes individuals on combination antihypertensive therapy. Means are adjusted for age, gender, ethnicity, health insurance status, smoking status, physical activity, education, and number of antihypertensive medications taken. BMI = body mass index; BB = β-blocker; DIUR = diuretic; CCB = calcium channel blocker; NW = normal weight; OW = overweight; OB = obesity; SBP = systolic blood pressure; DBP = diastolic blood pressure. ^∗Difference between users and nonusers significantly different from normal weight (P < 0.05); ^† difference between users and nonusers significantly different from overweight (P < 0.05).

Figure 2

Mean blood pressures (mmHg) among hypertensive adults using (a) ACE Inhibitors and (b) ARBs by BMI category and gender. Sample includes individuals on combination antihypertensive therapy. Means are adjusted for age, ethnicity, health insurance status, smoking status, physical activity, education, and number of antihypertensive medications taken. BMI = body mass index; ACE = ACE inhibitor; ARB = angiotensin receptor blocker; NW = normal weight; OW = overweight; OB = obesity; BP = blood pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure. ^∗Difference between users and nonusers significantly different from normal weight (P < 0.05); ^†difference between users and nonusers significantly different from overweight (P < 0.05).

Figure 3

Adjusted means for cardiometabolic risk factors by antihypertensive medication type. All models adjusted for age, gender, BMI, education, health insurance, smoking, and physical activity levels. Further adjustment for type 2 diabetes performed on FPG. ACE = ACE inhibitor; BB = β-blocker; DI = diuretics; CCB = calcium channel blocker; ARB = angiotensin receptor blocker; TG = triglyceride; HDL = high-density lipoprotein; WC = waist circumference. a = significantly different from No BP Drug (P < 0.05); b = significantly different from diuretics (P < 0.05); c = significantly different from BB (P < 0.05); d = significantly different from CCB (P < 0.05). Dashed line is the no BP drug group.