Obesity combined with hypertension: How to use medication to assist in scientific weight loss?

Drug Therapy: Human blood pressure is affected by many factors. Any disruption to any part or link in the blood pressure regulation system can cause changes in blood pressure. Antihypertensive drugs work by acting on one or more parts of the blood pressure regulation system. Based on their primary site of action, antihypertensive drugs are classified into diuretics, sympathetic nerve inhibitors, angiotensin-converting enzyme inhibitors, calcium channel blockers, and vasodilators.

(I) Diuretics

1. Pharmacological Actions
Diuretics inhibit the reabsorption of sodium and water by the renal tubules, increasing sodium excretion, reducing blood volume and extracellular fluid, thereby decreasing cardiac output and lowering blood pressure.

2. Drug Use and Antihypertensive Application
Diuretics can be used alone or in combination with other antihypertensive drugs such as β-blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers to treat hypertension.

(1) Thiazide Diuretics
Hydrochlorothide
Oral administration, 12.5–25 mg once or twice daily. Hydrochlorothiazide has a slow peak effect on blood pressure, requiring a period of time after administration to show its antihypertensive effect, and it also has certain side effects. Clinically, it can be used in combination with enzyme inhibitors to reduce adverse reactions such as hypokalemia and changes in glucose tolerance, especially in young hypertensive patients who often have high renin activity. Thiazide diuretics are prone to metabolic adverse reactions and are generally not used alone.

(2) Myelodiuretics: Furosemide (20mg orally, once or twice daily). Furosemide has a short duration of action; a single dose is insufficient to maintain a negative sodium balance for 24 hours. Furosemide's diuretic effect is too strong, and its sodium and potassium excretion effects are also very strong, easily causing adverse reactions. Clinically, it is mostly used for hypertensive crises or hypertensive patients with renal insufficiency and azotemia.

(3) Potassium-sparing diuretics: Spironolactone (20mg orally, 2-3 times daily). When used for hypertension caused by aldosteronism, a higher dose can be added.

Triamterne: Oral administration, 50-100 mg once, 2-3 times daily.

Potassium-sparing diuretics can be used in combination with thiazides or mixed diuretics to reduce the occurrence of hypokalemia, but are contraindicated in patients with renal insufficiency to prevent hyperkalemia.

(II) Sympathetic Nerve Depressants

1. Central Sympathetic Nerve Depressants

(1) Pharmacological Action
Central sympathetic nerve depressants act on the central nervous system, stimulating central α-adrenergic receptors to block sympathetic nerve impulses to the heart, kidneys, and peripheral blood vessels, thereby reducing peripheral resistance, cardiac output, and heart rate, resulting in a hypotensive effect. They generally have no significant effect on renal blood flow and glomerular filtration rate. (2) Drugs and Antihypertensive Use

Clonidine: Oral administration, 0.075–0.15 mg once, 2–3 times daily. It has a synergistic effect when used in combination with diuretics. Clonidine is not suitable for patients with a depressed central nervous system. Abrupt discontinuation after long-term use can lead to sympathetic hyperactivity and rebound hypertension. Sudden discontinuation due to fever should be avoided.

Methyldopa: Oral administration, 250 mg once, 2–3 times daily. With long-term use, approximately 10%–20% of patients may develop a positive Coombs test, and a small number may develop hemolytic anemia, requiring immediate discontinuation. Furthermore, methyldopa can cause hepatocellular damage, therefore it is contraindicated in patients with liver disease.