Showing papers by "Luis M. Ruilope published in 2002"

Hypertension magnitude and management in the elderly population of Spain

Abstract: Objective The present study assessed the prevalence, awareness, treatment and control of hypertension among the elderly population of Spain.Design Based on a nationally representative sample of 4009 individuals aged ≥ 60 years, two sets of six blood pressure measurements were obtained by trained obs

Antihypertensive treatment in patients with type-2 diabetes mellitus: what guidance from recent controlled randomized trials?

Abstract: Background Patients with type-2 diabetes have a high prevalence of hypertension and show an elevated incidence of cardiovascular events and nephropathy. Objectives Recent randomized trials of antihypertensive therapy providing information about cardiovascular and renal risk in diabetes, blood pressure goals and best suitable drugs were reviewed. Findings Evidence that association of type-2 diabetes with hypertension markedly increases cardiovascular and renal risk is incontrovertible: even blood pressure values in the high-normal range represent a more relevant risk than in non-diabetics. More versus less intensive blood pressure lowering or active versus placebo treatment can significantly prevent cardiovascular and renal events, with a particularly consistent reduction of proteinuria and microalbuminuria. Although several of the trials showing significant reduction of cardiovascular or renal risk achieved diastolic blood pressure (DBP) between 75 and 82 mmHg, systolic blood pressure (SBP) < 140 mmHg was never achieved in trials showing cardiovascular benefits and SBP < 130 mmHg was only achieved in two trials in normotensive subjects showing proteinuria reduction. The recommendation given by all major guidelines to lower SBP < 130 mmHg appears to be difficult to comply with. Evidence of the superiority or inferiority of different drug classes (angiotensin-converting enzyme inhibitors, calcium antagonists, diuretics and beta-blockers) is rather vague, especially for cardiovascular protection. As to angiotensin-receptor antagonists, losartan has shown significant cardiovascular protection over a beta-blocker, and irbesartan, although not showing cardiovascular benefits over a calcium antagonist, was significantly better in retarding renal dysfunction and failure. Conclusions In most trials on hypertensive diabetics, the large majority of patients were on two, three and even four-drug therapy. Therefore, it appears reasonable that all effective and well tolerated antihypertensive agents can be used in association to achieve DBP < 80 mmHg and, whenever possible, SBP < 130 or 135 mmHg, with the regular inclusion of an angiotensin-receptor antagonist for its proven renoprotective action. Hopefully, better guidance will be provided by further trials.

Pathophysiologic and therapeutic importance of tissue ACE: a consensus report.

Abstract: Angiotensin-converting enzyme (ACE) activation and the de novo production of angiotensin II contribute to cardiovascular disease through direct pathological tissue effects, including vascular remodeling and inflammation, as well as indirect action on nitric oxide bioavailability and its consequences. The endothelium plays a pivotal role in both vascular function and structure; thus, the predominant localization of ACE to the endothelium has implications for the pathobiology of vascular disease, such as coronary artery disease. Numerous experimental studies and clinical trials support the emerging realization that tissue ACE is a vital therapeutic target, and that its inhibition may restore endothelial function or prevent endothelial dysfunction. These effects exceed those attributable to blood pressure reduction alone; hence, ACE inhibitors may exert an important part of their effects through direct tissue action. Pharmacologic studies show that while ACE inhibitors may differ according to their binding affinity for tissue ACE the clinical significance remains to be determined.

The Framingham prediction rule is not valid in a European population of treated hypertensive patients.

Abstract: Background Stratification of population groups according to cardiovascular risk level is recommended for primary prevention.Objective To assess whether the Framingham models could accurately predict the absolute risk of coronary heart disease (CHD) and stroke in a large cohort of middle-aged Europea

Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy.

Abstract: Background It has been reported that aspirin (ASA) may interfere with the blood pressure (BP)-lowering effect of various antihypertensive agents and attenuate the beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in patients with congestive heart failure.Methods and results Data f

Antihypertensive Efficacy and Tolerability of Lercanidipine in Daily Clinical Practice. The ELYPSE Study

Abstract: Aim : Lercanidipine, a long-acting dihydropyridine with a good antihypertensive efficacy and tolerability in clinical use With the aim to determine the efficacy and tolerability of this drug in usual clinical practice we performed the ELYPSE trial Methods : Grade 1 or 2 essential hypertensive patients in whom their physicians considered to prescribe a dihydropyridine were conferred to Lercanidipine 10 mg once daily with a 3-month follow-up; 9059 patients were included (age: 63 - 11 years; 58% women, 60% over 60 years, 56% grade 2 hypertensives and 69% previously treated with other antihypertensive drugs) A subgroup of 1267 patients (14%) who were included in the study had experienced adverse reactions with other drugs Electronic case-report forms and a central database (Internet) were used in this trial Results : At baseline, blood pressure (BP) was 1601 - 102/956 - 66 mmHg; and heart rate (HR) 773 - 93 beats/min Significant reductions in both systolic and diastolic BP were attaine

How relevant and frequent is the presence of mild renal insufficiency in essential hypertension

Abstract: Recent analyses of the influence of renal function on the cardiovascular outcome in essential hypertensive patients have confirmed the relevance of the kidney in cardiovascular prognosis even in the initial stages of renal failure. The evaluation of renal function in clinical practice is based mainly on the finding of changes in serum creatinine, but the estimation of creatinine clearance or its determination after 24-hour urine collection is not usually performed. The objective of this study was to analyze the prevalence of mild chronic renal insufficiency (MCRI) through the determination of creatinine clearance in patients with essential hypertension to reinforce the need to consider using this parameter in daily clinical practice. We analyzed clinical and biochemical data from 2686 essential hypertension patients referred to our unit from 1979-1999. MCRI was defined as a serum creatinine > or =1.5 mg/dL in men and > or =1.4 mg/dL in women, or a creatinine clearance estimated by the Cockroft-Gault formula or by a 24-hour urine collection of <60 mL/min. A prevalence of MCRI was found in 7.6% according to serum creatinine levels. This prevalence increased to 22.3% and 21.5% respectively when the diagnostic criteria for MCRI was the estimation of 24-hour creatinine clearance in urine, or its estimation using the Cockroft-Gault formula. When classified by creatinine clearance values, patients with MCRI were characterized by older age, elevated systolic blood pressure, higher serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides, lower levels of high-density lipoprotein cholesterol, higher serum uric acid, fasting serum glucose, serum potassium, and higher levels of urinary albumin excretion. In summary, MCRI is more prevalent in essential hypertension than previously thought, particularly if the estimated creatinine clearance is used to define MCRI. The finding of an altered renal function is associated with a significant increase in cardiovascular risk. This fact reinforces the need to pay attention to any of the manifestations of renal damage observed in the usual clinical assessment of any hypertensive patient.

Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: A randomized double-blind trial

Abstract: Objective Guidelines recommend lower threshold and goal blood pressure (BP) for patients with proteinuria. BP reduction could be accompanied by a different fall in proteinuria depending of the antihypertensive drug. The objective was to compare proteinuria reduction when BP is lowered to the same level with different drugs. Design Prospective, randomized, double-blind, controlled trial. Setting 12 Spanish centres. Patients A total of 119 patients with primary renal disease, blood pressure > 130/85 mmHg, proteinuria > 1 g/day, and creatinine clearance ⩾ 50 ml/min. Intervention After a 4-week run-in placebo period, patients were randomized to: atenolol 50 mg/day; trandolapril 2 mg/day; verapamil 240 mg/day or verapamil 180 + trandolapril 2 mg/day combination; forced double-dose titration was carried out at the 4th week. Treatment duration was 6 months. Outcome measures Changes in BP, 24 h proteinuria, serum albumin and calcium. Results BP was significantly reduced with the four treatments [SBP/DBP (mmHg]: atenolol 12.2/9.9; trandolapril 12.9/9.3; verapamil 8.2/7.9 and verapamil + trandolapril 13.6/11.3) without differences between them. A significant fall in proteinuria was seen in the trandolapril, 40.2% [95% confidence interval (CI) 24.3–56.2%], and verapamil + trandolapril groups, 48.5% (95% CI, 31.7–64.3%) accompanied with increases in serum albumin (trandolapril: from 3.86 ± 0.64 to 4.03 ± 0.67 g/dl; verapamil + trandolapril: from 4.15 ± 0.58 to 4.40 ± 0.51 g/dl). Conclusions In patients with proteinuric primary renal disease, adequate dose titration of antihypertensive drugs may provide a substantial BP reduction. Only angiotensin-converting enzyme inhibitor (trandolapril) treatment, alone or better combined with verapamil, reduces proteinuria and increases serum albumin.

The Kidney as a Sensor of Cardiovascular Risk in Essential Hypertension

Abstract: Renal damage as a consequence of uncontrolled arterial hypertension is well recognized. Antihypertensive therapy has come to very significantly decrease the vascular damage in the kidneys of hypertensive patients. However, prevalence of mild renal insufficiency remains present in a significant proportion of the hypertensive population. This is accompanied by a marked increase in cardiovascular risk, as a consequence of the clustering of other cardiovascular risk factors and of insufficiently controlled BP. Prevention and protection of renal and cardiovascular damage in these patients will be one of the most relevant tasks in the future.

N-acetylcysteine potentiates the antihypertensive effect of ACE inhibitors in hypertensive patients

Abstract: Sulfhydryl group donors, such as N-acetylcysteine (NAC), may enhance the antihypertensive effect of some drugs through a nitric oxide (NO) mechanism. It has been observed that the hypotensive effect of angiotensin-converting enzyme inhibitors (ACEIs) is, at least partially, mediated by NO. We performed a within patient crossover study with the aim to investigate the potential effect of NAC on the ACEI antihypertensive action, via an NO-dependent mechanism. We studied 18 smoker (> 10 years of habit and > 10 cigarettes daily) hypertensive patients (15 males and three females, aged 69 +/- 5 years) on ACEI therapy (11 captopril and seven enalapril). Patients were randomly allocated to two treatment arms. In one arm, the patients (n = 10) initially received the addition of NAC (600 mg t.i.d.) to the ACEI regimen. In the other group (n = 8), the patients remained only on ACEI. After 21 days, the therapeutic patterns were crossed. The first group received only ACEI, and the second group received ACEI and NAC and completed other 21-day treatment period. We evaluate the effect of NAC on each patient by ambulatory blood pressure monitoring (ABPM), performed at the end of each therapeutic regimen. A significant decrease in systolic and diastolic 24-h blood pressure (24 hBP) and daytime BP (dtBP) was achieved with the combination of ACEI and NAC (ACEI + NAC) when compared to the period with only ACEI: 24 hBP = 146.1 +/- 4.2 vs 137 +/- 3.1 (p < 0.05) and 89.2 +/- 2.8 vs 83.5 +/- 3.7mmHg (p = 0.01). DtBP: 149.7 +/- 5.6 vs 141 +/- 3.7 and 92.1 +/- 4 vs 86 +/- 3.2 (both, p < 0.05). No significant difference was observed in night-time BP (ntBP). The NAC effect was not statistically different for the two ACEIs. In conclusion, the addition of NAC to an ACEI potentiates its antihypertensive effect during 24hBP and dtBP in smoker hypertensives. This effect may be mediated by an NO-dependent mechanism, probably through the protective effect of NAC on NO oxidation.

Valsartan improves fibrinolytic balance in atherosclerotic rabbits.

Abstract: Objectives To examine the long-term effects of the angiotensin type I (AT 1 ) receptor antagonist, valsartan, on fibrinolytic balance, coagulation parameters, endothelial function and structural alterations in atherosclerotic rabbits. Methods Animals were submitted to a 1% cholesterol-enriched diet for 10 weeks. Half of the animals were treated with valsartan (3 or 10 mg/kg per day). Systolic arterial pressure was directly measured in awake rabbits. Tissue plasminogen activator (t-PA) and tissue plasminogen activator inhibitor (PAI-1) activities were measured. Plasma concentrations of cholesterol, D-dimer, factor VIII and fibrinogen, as well as thrombin time, were also determined. Responses to acetylcholine, sodium nitroprusside and angiotensin II were evaluated in aortic rings. Morphometric analysis of aortic segments was also performed to calculate atherosclerotic lesion. Results Cholesterol-fed rabbits presented systolic arterial pressure levels comparable to controls. These animals presented aortic atherosclerotic lesions. Treatment with valsartan did not alter plasma cholesterol levels or arterial pressure in any group. Acetylcholine-induced relaxations and D-dimer and t-PA activity were lower (P< 0.05) in atherosclerotic than in normal rabbits. In contrast, PAI-1 activity was higher (P< 0.05) in atherosclerotic rabbits than in controls. Valsartan increased (P< 0.05) acetylcholine-induced relaxations, D-dimer concentration and t-PA activity, and reduced intimal thickening and PAI-1 activity in cholesterol-fed rabbits. Fibrinogen concentrations and factor VIII concentrations were lower (P< 0.05) and thrombin time was higher (P< 0.05) in atherosclerotic rabbits compared to controls. Valsartan did not affect factor VIII in any group, but reduced fibrinogen levels only in hypercholesterolemic rabbits. Valsartan 10 mg/kg per day reduced (P < 0.05) thrombin time in cholesterol-fed rabbits. Conclusions Impairment of fibrinolytic balance, associated with atherosclerosis in rabbits, appears to be related with angiotensin II via AT 1 receptors. The beneficial effect of valsartan on fibrinolysis seems to be related to the concomitant amelioration of endothelial dysfunction and reduction of intimal thickening, further supporting the importance of the blockade of angiotensin II actions to prevent thrombotic alterations associated with atherosclerosis.

Proteinuria: an underappreciated risk factor in cardiovascular disease.

Abstract: Changes in renal function produced by hypertension appear to be associated with higher cardiovascular morbidity and mortality. Indices of altered renal function (eg, micro-albuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance, or overt proteinuria) are independent predictors of cardiovascular morbidity and mortality. The Framingham Heart Study documented the relevance of proteinuria for cardiovascular prognosis in the community. The International Nifedipine GITS study: Intervention as a goal in Hypertension Treatment (INSIGHT) study assessed the role of proteinuria as a very powerful risk factor. Several studies demonstrated that microalbuminuria is a predictor of cardiovascular disease. It has been shown that the presence of microalbuminuria in primary hypertension carries an elevated cardiovascular risk. Furthermore, recent data indicate that even minor derangements of renal function are associated with an increase in cardiovascular risk factors, and promote progression of atherosclerosis. All these parameters should routinely be evaluated in clinical practice, and in the future must be considered in any stratification of cardiovascular risk in hypertensive patients.

Factors influencing the systolic blood pressure response to drug therapy.

Abstract: In the early stage of hypertension, diastolic blood pressure has greater prognostic importance, but in the elderly, systolic blood pressure is the most important marker of cardiovascular complications. Therefore, the need for more strict control of this component of blood pressure must be reconsidered. The benefit obtained in different studies in the elderly suggests that the treatment of isolated systolic hypertension is associated with a reduction in overall cardiovascular mortality of 22%, in coronary heart disease mortality of 26%, and in stroke mortality of 33%. However, a higher percentage of patients (73%) attain the diastolic goal of <90 mm Hg, while only 34% have systolic pressure reduced to <140 mm Hg. In a review of randomized trials comparing at least four different antihypertensive drugs, significant differences in systolic blood pressure reduction have not been demonstrated, except in black populations, in whom calcium channel blockers and diuretics seem to be more effective. In patients with isolated systolic hypertension, data are inconclusive, but calcium channel blockers and diuretics appear to lower blood pressure to a greater degree than do other antihypertensive drugs. Two main predictors of difficulty in controlling systolic blood pressure are the baseline blood pressure and the presence of diabetes. Other predictors are the duration of arterial hypertension, older age, the presence of target organ damage and associated clinical conditions (myocardial infarction, stroke, chronic renal failure), and an elevated serum uric acid level. It appears that the profile of patients with a poorer therapeutic response includes a greater severity of hypertension and/or the presence of cardiovascular disease.

Renal dysfunction as a cardiovascular risk factor.

Abstract: Indices of altered renal function (eg, microalbuminuria, increased serum creatinine concentration, or decrease in estimated creatinine clearance, particularly overt proteinuria) are independent predictors of cardiovascular morbidity and mortality. These parameters should be routinely evaluated in the elderly and in high cardiovascular risk populations, particularly when hypertension is present. Hypertensive kidney damage should be prevented by early aggressive treatment of hypertensive patients with microalbuminuria. To avoid further aggravation of high cardiovascular risk, antihypertensive agents devoid of unwanted metabolic side effects should be used. Epidemiologic information suggests that renal and cardiovascular outcome run parallel in this segment of the population.

AT1 blockers and uric acid metabolism: are there relevant differences?

Abstract: Background Serum urate is commonly elevated in essential hypertension (26-33%). Some studies have claimed that losartan increases urinary uric acid excretion and diminishes serum urate levels. However, a detailed, controlled study on the influence of losartan on uric acid metabolism in hypertensive patients has not been performed and the existent results are conflicting. Two small studies claimed that losartan reduced serum urate levels but only one showed a simultaneous increased uric acid excretion rate. The development of several AT 1 receptor blockers raises the question whether these antihypertensive drugs influence uric acid metabolism. Study In a randomized, prospective (4 weeks), double blind, parallel study we have compared the influence of losartan (50 mg/day) versus eprosartan (600 mg/day) on uric acid metabolism in 58 patients with mild to moderate essential hypertension. The mean uric acid to creatinine ratio change from baseline at 4 weeks was +0.11 for losartan and -0.04 for eprosartan (P < 0.01). The mean increase in 24-h urinary uric acid excretion with losartan was +0.7 mmol/24 h (25% increase from baseline). The change in serum urate levels versus baseline was similar after 4 weeks with losartan (-23.4 μmol/l) and eprosartan (-19.5 μmol/l). Patients with hyperuricemia in both treatment groups showed similar modifications of uric acid metabolism compared with non-hyperuricemic subjects. Blood pressure control was achieved in 22 patients (73%) with eprosartan and in 16 (53%) with losartan. Conclusions Losartan increased uric acid excretion in hypertensive patients but eprosartan did not. Neither AT 1 receptor antagonist substantially modified serum urate concentrations.

Losartan titration versus diuretic combination in type 2 diabetic patients.

Abstract: METHODS We compared the effects of Losartan dose titration to 100 mg versus the addition of 12.5 mg of hydrochlorothiazide, in 90 type 2 diabetic patients with microalbuminuria and blood pressure > 130/85 mmHg, receiving losartan 50 mg as initial treatment during 4 weeks. RESULTS With the first dose of losartan, systolic (SBP) and diastolic blood pressure (DBP) decreased from 154.5 (152.1-157.5) to 144.4 (141.3-147.5) mmHg (P < 0.001) and from 91.1 (89.4-92.8) to 84.6 (82.8-86.4) mmHg (P < 0.001), with 20 patients attaining the expected goal blood pressure (< 130/85 mmHg); albuminuria decreased from 109.8 (90.5-133.3) to 83.5 (63.6-109.5) mg per 24 h (P = 0.006). Patients not attaining the target blood pressure were randomly allocated to titration or to the combination arm. After an additional 4 weeks, patients titrated exhibited a fall in SBP and DBP from 157.1 (152.7-161.5) to 142.1 (136.4-147.8) mmHg (P < 0.001) and from 92.4 (89.5-95.3) to 83.6 (81.1-86.1) mmHg (P < 0.001); albuminuria decreased from 136.3 (97.8-189.9) to 99.7 (69.3-143.4) mg per 24 h (P = 0.002). In the combination arm, there were similar reductions in SBP and DBP from 155.3 (151.5-159.1) to 139.1 (132.1-146.1) mmHg (P < 0.001) and from 92.1 (89.3-94.9) to 80.9 (77.4-84.4) mmHg (P < 0.001); while albuminuria fell from 107.7 (82.2-141.0) to 64.2 (45.9-89.9) mg per 24 h (P = 0.001). CONCLUSIONS Losartan 50 mg was effective in reducing blood pressure and albuminuria in type 2 diabetic patients. When the blood pressure target was not reached, the two strategies tested seem to contribute similarly to further reductions in blood pressure and albuminuria.

Long-term protection in at-risk hypertensive patients--a role for nifedipine GITS?

Abstract: Hypertensive patients who are at high risk of developing cardiovascular (CV) complications have become the focus of modern treatment guidelines. The choice of antihypertensive therapies in these patients should be evidence-based: in particular, there should be evidence of a beneficial impact on CV events in addition to blood pressure-lowering effects. The International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT) is the first, large, randomized, double-blind study undertaken exclusively in high-risk hypertensive patients, with CV events as a prospectively defined primary end-point. The choice of a diuretic (co-amilozide) as a comparator reflects the fact that this group of antihypertensive drugs has been shown to reduce CV events in high-risk hypertensive patients. Nifedipine, administered in a long-acting gastrointestinal-transport-system (GITS) formulation, and coamilozide were equally effective in preventing overall CV or cerebrovascular complications. This finding ...

Renal protection by antihypertensive therapy.

Abstract: The attainment of adequate renal protection requires strict blood pressure control and a diminution of proteinuria or microalbuminuria to values as near from normalcy as possible. It has been considered that by getting the first, the second could be attained at the same price. Recent data have confirmed that renal protection in hypertensive patients, diabetics or not, requires combination therapy that has to include an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker. A calcium channel blocker can be added to this without renal compromise. A diuretic will also be needed in most cases. Proteinuria will diminish with this combination in particular if up-titration of the drug blocking the effects of angiotensin II is performed. The control of other associated risk factors is also required, in particular smoking and lipids.

The effect of nifedipine GITS on outcomes in patients with previous myocardial infarction: A subgroup analysis of the INSIGHT study

Abstract: Post-myocardial infarction (Ml) patients have a higher risk for subsequent cardiovascular and cerebrovascular events than the average population. This study was to test the effects on outcomes of nifedipine GITS compared to the diuretic combination co-amilozide in hypertensive patients with a history of Ml on outcomes (subset of the INSIGHT study). The multinational, randomised, double-blind International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) study compared the treatment effects of nifedipine GITS 30 mg and co-amilozide (hydrochlorothiazide 25 mg plus amiloride 2.5 mg) in hypertensive patients aged 55-80 years with a blood pressure of 150/95 mmHg (or 160 mmHg systolic). This pre-specified subanalysis was performed in patients with a history of Ml. The primary outcome was a composite of cardiovascular death, non-fatal stroke, Ml, and heart failure. Of 6,321 randomised patients, 383 (6.1%) had a previous Ml. The percentage of primary outcomes in post-MI patients did not differ between the two treatment groups (14.9%). The number of post-MI patients with composite secondary outcomes was 53 (27.2%) in the nifedipine GITS group and 60 (31.9%) in the co-amilozide group. The incidence rates of primary and secondary outcomes were higher in patients with a previous Ml than in patients without a history of Ml. For the randomised use of nifedipine GITS and co-amilozide in hypertensive patients with a previous Ml, the choice seemed unimportant for outcomes and blood pressure lowering. The results of this subgroup analysis are consistent with INSIGHT's overall findings of no significant differences in efficacy, suggesting that post-MI hypertensive patients are no more likely to suffer further events when treated with long-acting nifedipine than on co-amilozide.

Inhibidores selectivos de la ciclooxigenasa-2 (Coxibs) y morbilidad cardiovascular

Abstract: Los antiinflamatorios no esteroideos (AINE) han probado sobradamente su eficacia como analgesicos y antiinflamatorios, aunque el efecto beneficioso que se pretende alcanzar se acompana, en un numero no despreciable de pacientes, de toxicidad gastroduodenal en forma de diatesis hemorragica. La tendencia a la hemorragia digestiva esta probablemente relacionada con la inhibicion de una de las isoformas de la ciclooxigenasa, la llamada COX-1, pues tal isoforma predomina en la mucosa gastrica y promueve la sintesis de prostaglandinas protectoras, proteccion que es neutralizada por los AINE. La identificacion de otra isoforma, la ciclooxigenasa 2 (COX-2), en monocitos estimulados por interleucina permitio la produccion de farmacos capaces de inhibir selectivamente la COX-2. La obtencion de similares efectos antiinflamatorios exentos de toxicidad gastroduodenal se supone en relacion con el hecho de que la COX-2 es inducida por el propio proceso inflamatorio y causante del dolor y edema local

Obesity, cardiovascular risk and pharmacotherapy.

Abstract: The prevalence of obesity is continuously rising in both USA and Europe [1]. An increased body mass index (BMI) has been shown to correlate with an increased risk of death from all causes, including cardiovascular disease, cancer and other diseases [2, 3]. The augmented risk is seen throughout the range of moderate and severe overweight, for both men and women, and at all ages [2]. Besides, being an independent risk factor for cardiovascular disease, obesity, particularly of the visceral type, has been repeatedly shown to be associated with a long list of associated risk factors and predictors of cardiovascular disease listed in Table I [4]. As an example, overweight and obesity are present in 80% of the hypertensive population currently being followed in hospital-located hypertension units in Spain [5]. Most of these obese hypertensives are classiŽ ed as having a high or very high risk, according to commonly used hypertension-related guidelines [6, 7] that do not consider obesity as an isolated factor for the stratiŽ cation of risk. Correction of an increased body weight can then be considered a primary objective for the prevention of both cardiovascular and renal disease [8]. Such a correction will undoubtedly have beneŽ ts for the health of patients and will contribute to diminishing the cost of medical care that is directly proportional to the BMI of any given patient [9].