Pharmacotherapeutic Strategies for Treating Hypertension in Patients with Obesity


Selecting an optimal combination of drugs to promote health improvement is a challenging task. The reason for this is the existence of multiple factors, including specific health conditions, age, or sex, that might influence drugs’ effectiveness. The purpose of this paper is to explore the case of AO with attention to the effects of obesity on pharmacokinetic and pharmacodynamic processes and drug therapy.

Obesity’s Influences on Pharmacodynamic and Pharmacokinetic Processes

AO’s obesity, the pathophysiology of which can be linked with a variety of environmental, socioeconomic, and individual genetic influences, can slightly affect the movement of drugs in the body. Obesity affects intestinal permeability, gastric emptying time/rate, and liver function, which might cause alterations in drugs’ pharmacokinetic properties. Current studies suggest that obesity does not heavily influence gastrointestinal absorption processes, whereas the volume of distribution of the drugs can be altered, with the degree of change depending on the drug’s binding affinities (May et al., 2020). Being obese, AO can have specific hepatic metabolism patterns, including reduced rates of metabolism via CYP3A4 isoenzymes and accelerated metabolism by uridine diphosphate glucuronosyltransferases and CYP2E1 (May et al., 2020).

Some phase II hepatic metabolism reactions, such as sulfation and glucuronidation, might be accelerated in high-BMI patients, especially obese men (May et al., 2020). Therefore, the selected factor might influence certain pharmacokinetic processes in AO’s situation.

In terms of changes to pharmacodynamic processes, research findings are rather scarce, but obesity has been shown to affect drug effectiveness only in relation to very specific drugs. Among them are opioid analgesic drugs and benzodiazepines, the effects of which might be more pronounced in high-BMI individuals, resulting in the intensification of obstructive sleep apnea symptoms (Smit et al., 2018). The list of drugs taken by AO does not contain such products.

Changes in the Processes and Drug Therapy

The changes above are representative of general alterations to processes affecting obese patients’ reactions to pharmaceutical treatment. Depending on AO’s unknown characteristics, including age, gender, and current BMI, they might impact optimal dosing and drug selection recommendations. For instance, beta-blocker therapies used for managing hypertension can promote further decreases in metabolic rates (Carnagarin et al., 2018). Given AO’s obesity, this could promote further weight gains (up to 3.5 kg) when taking high doses of atenolol or other beta-blockers (Carnagarin et al., 2018; Coats, 2020).

In contrast, alpha-blockers, such as doxazosin, could be extremely beneficial for AO’s health since their anti-hypertensive effects might be even more pronounced in those with elevated BMI levels (Carnagarin et al., 2018). AO’s recent weight gains might also impose limitations peculiar to tricyclic antidepressants with sedative effects. Specifically, amitryptiline promotes weight gains, so the use of sertraline, its possible alternative, is a better option (May et al., 2020). The patient’s degree of obesity, which is not indicated in the case, should be a crucial factor in assessing the risk-benefit ratios of certain drug types and updates to recommended dosages.

Possible Improvements to the Drug Therapy Plan

Adapting drug dosages to AO might require more detailed investigations of patient history and individual reactions to drugs. Based on the provided information, in AO’s case, the current pharmaceutical treatment plan seems appropriate given that the current doses of beta-blockers and antidepressants are significantly lower than usual adult doses. One improvement that could promote better outcomes is adding a usual adult dose or a smaller dose of one thiazide diuretic drug that would also promote BP reductions and prevent excessive fluid accumulation in obesity-related hypertension (Carnagarin et al., 2018). The patient’s weight gain, if it has been rapid, can stem from water retention, and diuretics would be necessary if this hypothesis is correct.


In summary, based on what is known about obesity and the body’s responses to drugs, obesity might create extra health risks linked with taking benzodiazepines and opioid drugs. Beta-blockers and some antidepressants could promote further weight gains in AO’s case, but the currently prescribed doses are adequate. The recommended improvement involves adding a diuretic drug if AO’s weight gain is attributable to abnormal fluid accumulation.


Carnagarin, R., Matthews, V., Gregory, C., & Schlaich, M. P. (2018). Pharmacotherapeutic strategies for treating hypertension in patients with obesity. Expert Opinion on Pharmacotherapy, 19(7), 643-651. Web.

Coats, A. J. S. (2020). Beta-blockers, hypertension, and weight gain: The farmer, the chicken, and the egg. Hong Kong Medical Journal, 26(1), 1-7. Web.

May, M., Schindler, C., & Engeli, S. (2020). Modern pharmacological treatment of obese patients. Therapeutic Advances in Endocrinology and Metabolism, 11, 1-19. Web.

Smit, C., De Hoogd, S., Brüggemann, R. J. M., & Knibbe, C. A. J. (2018). Obesity and drug pharmacology: A review of the influence of obesity on pharmacokinetic and pharmacodynamic parameters. Expert Opinion on Drug Metabolism & Toxicology, 14(3), 275–285. Web.

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