LAUSR

BACKGROUND Previous studies have reported that lean hypertensives have worse clinical outcomes than obese hypertensives. Other studies have shown that obesity confers pharmacological resistance to antihypertensive therapy. We explored whether the higher prescribed doses of antihypertensive medications in obese hypertensives were adequate for the attainment of similar on-treatment blood pressure (BP) compared to their leaner counterparts. METHODS A retrospective electronic health record review was undertaken in a de-identified database (N=851; predominately African American and female from an urban referral hypertension cohort. Median follow-up was 11.3 months (95% confidence interval (CI) (11.0, 11.5). Body mass index (BMI) kg/m2 was categorized as either below or above or equal to 30. Antihypertensive therapeutic intensity score (TIS) was the total daily antihypertensive dose/maximum United States Food and Drug Administration (USFDA) approved daily dose, summed across all hypertensive drugs. General linear models were used to estimate the statistical significance of continuous variables across BMI categories. RESULTS At baseline, systolic blood pressure (SBP) was similar between groups (p = 0.14), though it was 2.7 mm higher in the highest BMI group. Antihypertensive therapeutic intensity score (TIS) was greater in the highest BMI category at both baseline and at the end of follow-up (both P < 0.001). After covariate adjustment end of follow-up SBP and diastolic blood pressure (DBP) were higher in the obese compared to the non-obese group by 3.4 (0.6-6.1) /1.8 (0.1-3.53) mm Hg (p = 0.02, p = 0.04). CONCLUSIONS Attained on-treatment BP is higher in obese than non-obese hypertensives despite greater prescription of antihypertensive medications. Whether even more prescription of medications or other interventions will equalize BP responses relative to non-obese hypertensives merits further study.