Treatment of hypertension with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and resting metabolic rate: A cross-sectional study

Abstract

Hypertension in obese and overweight patients is associated with an elevated resting metabolic rate (RMR). The aim of this study was to determine whether RMR is reduced in hypertensive patients treated with angiotensin-converting enzyme inhibitors (ACEI) and blockers (ARB). The RMR was determined by indirect calorimetry in 174 volunteers; 93 (46.5 %) were hypertensive, of which 16 men and 13 women were treated with ACEI/ARB, while 30 men and 19 women with untreated hypertension served as a control group. Treated and untreated hypertensives had similar age, BMI, physical activity, and cardiorespiratory fitness. The RMR normalized to the lean body mass (LBM) was 15% higher in the untreated than ACEI/ARB-treated hypertensive women (p = .003). After accounting for LBM, whole-body fat mass, age, the double product (heart rate x systolic blood pressure), and the distance walked per day, the RMR was 2.9% lower in the patients taking ACEI/ARB (p = .26, treatment x sex interaction p = .005). LBM, age, and the double product explained 78% of the variability in RMR (R² = 0.78, p < .001). In contrast, fat mass, the distance walked per day, and total T4 or TSH did not add predictive power to the model. Compared to men, a greater RMR per kg of LBM was observed in untreated hypertensive overweight and obese women, while this sex difference was not observed in patients treated with ACEI or ARBs. In conclusion, our results indicate that elevated RMR per kg of LBM may be normalized by antagonizing the renin-angiotensin system.

Keywords: angiotensin; exercise; obesity; overweight; resting energy expenditure; women.

FIGURE 1

Resting metabolic rate (BMR) in overweight women and men with hypertension treated with angiotensin‐converting enzyme inhibitors (ACEI) and blockers (ARB) or who were untreated. The extremes of the whiskers represent the limits of the 5^th and 95^th percentiles, respectively; the thin and thick horizontal lines inside the boxes correspond to the mean and median values, respectively; and the lower and upper limits of the box delimit the 1^st and 3^rd quartiles, respectively. N = 78, 29 were ACEI/ARB treated patients (Men/Women: 16/13) and 49 untreated hypertensives (Men/Women: 30/19). “p” values represent the comparison between treated and untreated hypertensives