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ABDOMINAL OBESITY DECREASES ANTIHYPERTENSIVE EFFECT OF AMLODIPINE IN OUT-WARD PATIENTS

V. Kosmálová, J. Lietava, V. Husárová, P. Makara, A. Dukát (Bratislava, SR)

Topic: Primary prevention

Type: Poster - doctors, 14th CSC Annual Congress

Metabolic syndrom (MS) represents analogous risk for ischemic heart disease as high LDL, but its therapy is until now underestimated in ambulant praxis. Effortless measurement of abdominal obesity (AO), which is leading component of MS, is missing in practise. Generally is therapy of MS pointed to management of hypertension or dyslipidemia. Therapy of hypertension should be iniciated from the level of 130/85 mm Hg, and the target value is below this value. However, effect of the antihypertensive therapy in respect to AO in clinical praxis has not been followed in Slovakia.

Method: Effect of short term (three month) therapy with amlodipine was followed in 1505 pts (39.5% males; 60.5% females) with arterial hypertension aged 60.4±11.6 yrs and BMI 27.8 ±3.82. AO was defined according to ATP III criteria - patients were split into subgroups according to abdominal circumference ≥ 102 cm for males and ≥ 94 for females. We compared effect of 5 mg, resp. 10 mg daily dose of amlodipine in relation to presence or absence of increased AO.
Results. Female population had more frequently abdomimal obesity (45.1% vs. 24.7%). Patients with AO decreased blood pressure (δBP) significantly more with dose of 10 mg amlodipine. Patients with normal waist circumference decreased blood pressure similarly irrespectively of the dose of amlodipine (see Table):
                                    Males                                                    Females
                       AO (-)                   AO (+)                      AO (-)                    AO(+)
mmHg          δSBP δDBP         δSBP   δDBP               δSBP   δDBP          δSBP     δDBP

Amlodipine
10 mg            21,3    16,3        42,5    27,3               21,3       16,3           30,5       14,1
  5 mg            22,5    15,2       27,5     12,1               22,5       15,2           23,4       15,5
Significance   NS      NS        0.001    0.01             NS          NS             0.01      NS

Conclusion: Patients with arterial hypertension and abdominal obesity required higher initial dose of amlodipine in comparison with patients with normal waist circumference.