Sibutramine hypertension with

Primary pulmonary hypertension and cardiac valve disorders have been associated with other centrally acting weight loss agents that cause release of serotonin from nerve terminals although sibutramine has not been associated with these effects in premarketing clinical studies, patients should be informed of the potential for these side effects and monitored closely for their occurrence... 

As of 2002, it was not known whether sibutramine caused primary pulmonary hypertension. However, sibutramine was not recommended for people with conditions including heart disease, irregular heartbeat, or a history of stroke. 

In a study of the efficacy and safety of sibutramine in obese white and African Americans with hypertension, the most common adverse event resulting in withdrawal... 

The observation that sibutramine, which blocks the re-uptake of noradrenaline and serotonin and to a lesser extent dopamine (6), causes a raised blood pressure has been a cause of concern (1,16). Some insight into this problem and its magnitude comes from two recent studies (17,18). Most studies have shown a positive relation between blood pressure and weight (19). The failure of the blood pressure to fall with weight loss in normotensive and hypertensive patients treated with sibutramine differs from the fall seen with orlistat (20-22) or weight loss induced by life-style modifications (23,24). In the case of sibutramine, the potentially detrimental effect due to the failure of the blood pressure to fall with weight loss may be offset by the reductions in lipids, insulin, and uric acid that occur with weight loss (25). 

The effects of sibutramine on weight loss, blood pressure, and pulse rate in hypertensive obese patients, whose blood pressure was well controlled with a beta-blocker either alone or with a thiazide diuretic, have been evaluated in a 12-week, double-blind, placebo-controlled, parallel-group, randomized study in 69 patients (17). Sibutramine was effective and well tolerated and did not exacerbate pre-existing hypertension controlled with beta-blockers. Despite the presence of apparently effective beta-blockade, there were modest increases in pulse rate in those who took sibutramine, suggesting that mechanisms other than increased sympathetic tone may, at least in part, mediate this effect. Based on the potential for increased blood pressure and pulse rate, obese patients with well-controlled hypertension who are taking sibutramine should be monitored periodically (17). 

Faria AN, Ribeiro Filho FF, Lerario DD, Kohlmann N, Ferreira SR, Zanella MT. Effects of sibutramine on the treatment of obesity in patients with arterial hypertension. Arq Bras Cardiol 2002 78(2) 172-80. 

Sramek JJ, Leibowitz MT, Weinstein SP, Rowe ED, Mendel CM, Levy B, McMahon FG, Mullican WS, Toth PD, Cutler NR. Efficacy and safety of sibutramine for weight loss in obese patients with hypertension well controlled by beta-adrenergic blocking agents a placebo-controlled, double-blind, randomised trial J Hum Hypertens 2002 16(1) 13-19. 

McMahon FG, Weinstein SP, Rowe E, Ernst KR, Johnson F, Fujioka K. Sibutramine in Hypertensives Clinical Study Group. Sibutramine is safe and effective for weight loss in obese patients whose hypertension is well controlled with angiotensin-converting enzyme inhibitors. J Hum Hypertens 2002 16(1) 5-11. 

Sibutramine hydrochloride is an anorexiant that inhibits reuptake of norepinephrine, serotonin and dopamine. It may stimulate the satiety center in brain, causing appetite suppression. It is indicated as an adjunct to a reduced calorie diet for the management of obesity, including weight loss and maintenance of weight loss. Recommended for patients with an initial body mass index greater than 30 kg/m2 or greater than 27 kg/m in the presence of other risk factors (e.g., hypertension, diabetes, dyslipidemia). 

Sibutramine may be useful in patients where the obese state is characterised by overeating and snacking because of its appetite reducing effects. Sibutramine should not be used in patients with uncontrolled hypertension or with tachy-arrhythmia. Rimonabant may be preferred in obese patients with the metabolic syndrome particularly in those with low HDL and high triglyceride. Because of few data rimonabant should be avoided in patients with psychiatric illness, particularly in patients with major depressions and in patients in antidepressive treatment. These suggestions are not evidence based but the recommendations that can be used until more direct head-to-head investigations have been performed. 

In a randomised, double-blind study over 52 weeks in 220 obese, hypertensive patients, whose hypertension was well controlled with an ACE inhibitor (benazepril, enalapril or lisinopril) with or without a thiazide diuretic, two-thirds of the patients were also given sibutramine and one-third were given placebo. Sibutramine 20 mg daily caused small increases in mean blood pressure compared with placebo (133.1/85.5 mmHg compared with 130.4/82.8 mmHg, at 52 weeks, respectively), but overall, hypertension remained well controlled. ... 

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