The Association Between Antihypertensive Use and Blood Pressure is Influenced by Obesity

We examined whether blood pressure (BP) attained when using various antihypertensive medications differs by body mass index (BMI) and if antihypertensive medication use is associated with differences in other metabolic risk factors, independent of BMI. Individuals with hypertension from the National Health and Nutrition Examination Survey (NHANES) from 1999-2014 were used (n=15,285) to examine the main effects and interaction between antihypertensive use and BMI. Generally, antihypertensive users had lower BP than those taking no BP medications (NoBPMed) (P<0.05), whereby in women, the differences in systolic BP between angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) users and NoBPMed was greater in those with obesity compared to normal weight women (P<0.05). Diastolic BP differences between women ARB users and NoBPMed were also greatest in obesity (P<0.05) whilst there were no differences in normal weight individuals (P>0.05). Furthermore, glucose levels, and waist circumference (in women) were higher in those using ACE inhibitors compared to diuretics (P<0.05). ACE inhibitors and ARBs may be more beneficial for BP reduction in women with obesity. However, potential cardiometabolic side effects of antihypertensive medications should also be considered.