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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Does pharmacologically induced weight loss improve cardiovascular outcome? Sibutramine pharmacology and the cardiovascular system

Arya M. Sharma*

Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada

* Corresponding author. E-mail address: sharma{at}ccc.mcmaster.ca

The serotonin and noradrenaline re-uptake inhibitor, sibutramine, is a widely used anti-obesity drug that promotes weight loss by increasing satiety, although a mild increase in energy expenditure may also contribute. Noradrenaline re-uptake inhibition with sibutramine in peripheral tissues could theoretically exacerbate arterial hypertension through an increase in synaptic noradrenaline concentrations. This has led to a widespread perception that sibutramine contributes to hypertension and should not be used in patients at high risk of cardiovascular disease. However, neither published trials nor post hoc re-analysis of randomized trial data support this notion; the incidence of sustained blood pressure (BP) increase with sibutramine is not significantly different from control. Indeed, post-marketing surveillance data suggest a significant decrease in BP with sibutramine in obese hypertensives. The biological basis of this effect is underpinned by detailed consideration of adrenergic receptor pharmacology and confirmed by mechanistic studies.

Key Words: Blood pressure • Obesity • Sibutramine • Sympathomimetic effects • Weight loss


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Eur. Heart J. Suppl., November 1, 2005; 7(suppl_L): L44 - L48.
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