The treatment of obese hypertensive black women: a comparative study of chlorthalidone versus clonidine

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Objective: We attempted to determine a valid pharmacological approach for the control of high blood pressure in obese hypertensive patients using two antihypertensive agents with different pharmacological actionsDesign: Thirty-two obese hypertensive black women were randomly treated with chlorthalidone or clonidine to achieve adequate blood pressure control. Unresponsive patients received combination therapy with both agentsResults: Twenty-nine patients completed the study. Systolic and diastolic blood pressures were reduced with both agents, more so with chlorthalidone. Of the 15 patients treated with chlorthalidone, 14 had satisfactory reduction in diastolic pressure compared with only four of the 14 treated with clonidine. Of the 11 unresponsive patients treated with combination therapy, 10 achieved satisfactory control of blood pressureConclusions: We conclude that a rational approach to the treatment of hypertension in obese black women includes diuretics, a first choice attempt that tries to address the hemodynamic alterations previously identified in those patients. Combining diuretics with an α-adrenergic agonist resulted in complete control of blood pressure in most of the hypertensive patients in our study. The lowest dose of each antihypertensive medication, especially when used in combination, was effective in a high percentage of patients. The use of this antihypertensive approach also helps to clarify which of the underlying pathophysiological mechanisms should be targeted when other currently available antihypertensive medications are used

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