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Efficacy and Safety of Sibutramine in Obese White and African American Patients With Hypertension
A 1-Year, Double-blind, Placebo-Controlled, Multicenter Trial
F. Gilbert McMahon, MD, MS, FAACP;
Ken Fujioka, MD;
Bramah N. Singh, MD, PhD;
Carl M. Mendel, MD;
Everton Rowe, PhD;
Kelly Rolston;
Franklin Johnson, MS;
Arshag D. Mooradian, MD
Arch Intern Med. 2000;160:2185-2191.
Background Obesity is a highly prevalent medical condition and is commonly accompanied by hypertension. This study assessed the efficacy and safety of treatment with sibutramine hydrochloride for promoting and maintaining weight loss in obese patients with controlled hypertension, including a subset analysis of African American patients.
Patients and Methods Obese patients with a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) between 27 and 40 and a history of hypertension controlled with a calcium channel blocker (with or without concomitant thiazide diuretic treatment) were randomized to receive sibutramine (n = 150) or placebo (n = 74) with minimal behavioral intervention for 52 weeks. African Americans constituted 36% of enrolled patients. Efficacy assessments were body weight and related parameters (BMI and waist and hip circumferences), metabolic parameters (serum levels of triglycerides, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol, glucose, and uric acid), and quality-of-life measures. Safety assessments included recording of blood pressure, pulse rate, adverse events, and reasons for discontinuation.
Results For patients receiving sibutramine, weight loss occurred during the first 6 months of the trial and was maintained to the end of the 12-month treatment period. Among patients receiving sibutramine, 40.1% lost 5% or more of body weight (5% responders) and 13.4% lost 10% or more of body weight (10% responders) compared with 8.7% and 4.3% of patients in the placebo group, respectively (P<.05). Changes in body weight were similar among African Americans and whites. Sibutramine-induced weight loss was associated with significant improvements in serum levels of triglycerides, HDL-C, glucose, and uric acid. Waist circumference and quality-of-life measures also improved significantly in patients receiving sibutramine. Sibutramine-treated patients had small but statistically significant mean increases in diastolic blood pressure (2.0 mm Hg) and pulse rate (4.9 beats/min) compared with placebo-treated patients (–1.3 mm Hg and 0.0 beats/min; P<.05); these changes were similar among African Americans and whites. Most adverse events were mild to moderate in severity and transient. The most common adverse event resulting in discontinuation among patients receiving sibutramine was hypertension (5.3% of patients receiving sibutramine vs 1.4% of patients receiving placebo).
Conclusions In obese patients with controlled hypertension, sibutramine was an effective and well-tolerated treatment for weight loss and maintenance. Sibutramine-induced weight loss resulted in improvements in serum levels of triglycerides, HDL-C, uric acid, and glucose, and in waist circumference and quality-of-life measures. Blood pressure and heart rate increased by a small amount. Efficacy and safety profiles for sibutramine among African American and white obese patients with controlled hypertension were similar.
From the Clinical Research Center, New Orleans, La (Dr McMahon); Scripps Clinic, San Diego, Calif (Dr Fujioka); University of California–Los Angeles and West Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (Dr Singh); Knoll Pharmaceutical Company, Mount Olive, NJ (Drs Mendel and Rowe, Mr Johnson, and Ms Rolston); and the Division of Endocrinology, Department of Internal Medicine, St Louis University School of Medicine, St Louis, Mo (Dr Mooradian).
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