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These are times where losing weight should not concur with drug induced hypertension. This article is interesting in this respect.

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  1. 1. letter to the editor Diabetes, Obesity and Metabolism 13: 963–964, 2011. © 2011 Blackwell Publishing LtdPhentermine therapy for obesity does not elevate bloodpressureTo the Editor: The preponderance of published evidence suggests thatThe report by Kang et al. [1] of a clinical trial with a new blood pressure elevation because of phentermine is rare ratherdiffuse-controlled release of phentermine for obesity is timely than common in the context of obesity management.because phentermine is currently one of the few remaining Phentermine was approved for obesity treatment in 1959,approved drugs for obesity pharmacotherapy. We agree that long before the chronicity of obesity was acknowledged andthe study data supports the authors’ conclusions that this the Food and Drug Administration (FDA) began to requireformulation of phentermine is a safe and effective treatment long-term clinical trials for obesity drugs. In response to a longadjunct for treating obesity. We also agree that further long- simmering controversy, and after an extensive reevaluationterm studies of phentermine should be undertaken. In our of these obesity drugs, in 1977 the FDA formally reaffirmedopinion, phentermine pharmacotherapy for obesity is much amphetamine and its congeners, including phentermine, tosafer than is commonly assumed. Phentermine offers a high be effective for obesity treatment. However, in responsepotential of substantial benefit to obese patients, particularly to controversy regarding the addiction potential of thethose with moderate elevations of blood pressure, and it amphetamine congeners, and because most of the patientsshould be the first choice medicine when pharmacotherapy in clinical trials had only taken the drugs for 12 weeks, the FDAis considered for most obese patients. decided that these drugs should be used only a ‘few weeks’ [6]. Kang et al. mentioned that phentermine may elevate blood At that time, many private practice obesity treatment specialistspressure, even though they observed the opposite effect. Other already had 18 years of experience with these amphetaminethan a few anecdotes, there is little or no evidence in the congeners, had found them to be both effective and safe, andpeer-reviewed medical literature to support the often repeated were using them long term for patients in their practices. Fewconjecture that phentermine, when chronically administered, of these practitioners discontinued their patients’ medications when the FDA relabeled them for short term use only. (W.L. to the editorcan elevate blood pressure. The clinical trial reports cited by Asher, pers. comm.). Although the notion that phentermine letterKang et al. either did not report blood pressures or reported that should be used beyond 12 weeks did not begin to gain tractionphentermine-treated subjects had declines in blood pressure. in the medical literature until after Weintraub et al.’s studiesThe meta-analyses cited discuss elevations of blood pressure appeared beginning in 1984 [7], occasional earlier reports hadas adverse effects but provide no supporting data. Average suggested that the drugs could be used for longer durations thanblood pressures are known to decline when obese patients 12 weeks [8]. A recent survey of obesity treatment specialistslose weight without pharmacotherapy [2]. Obesity treatment in the US revealed that the majority of the specialists polledspecialists experienced with phentermine have known for now use phentermine, diethylpropion, and phendimetrazinesome time that average blood pressures also decline in long term [9]. We conclude that long-term phenterminepatients when phentermine is added to weight loss therapy. use has long been common in the US despite the FDAThese observations have recently been confirmed in two labeling.observational reports from private practices, one short term [3] We concur with Kang et al., that additional phentermineand the other long term [4]. In clinical trials for Qnexa, a efficacy and safety studies should be conducted. Since manycombination of phentermine and topiramate, investigators also physicians already use phentermine long term, the studiesobserved that the blood pressure declined in treated patients should be long term, at least 1 year in length.with the most pronounced declines occurring in patientswith preexisting hypertension [5]. The long-term phentermine E. J. Hendricks∗study mentioned above [4] found that phentermine-treated Center for Weight Management, Roseville, CA 95661, USApatients with preexisting hypertension had the greatest declinesin blood pressure, patients with preexisting prehypertensionhad lesser declines, while patients with initial optimum R. B. Rothmanblood pressures (<120/80) had no significant blood pressure Belite Medical Center, Fairfax, VA 22030, USAchanges. Long-term phentermine-treated patients had bettersuccess with weight loss maintenance and had blood pressure ∗ Center for Weight Management, 2510 Douglas Boulevard,declines that were persistent so long as weight loss was Suite 200, Roseville, CA 95661, USAmaintained. E-mail: edhendricks@surewest.net
  2. 2. letter to the editor DIABETES, OBESITY AND METABOLISMConflict of Interest 4. Hendricks EJ, Greenway FL, Westman EC, Gupta AK. Blood pressure and heart rate effects, weight loss and maintenance during long-termDr Hendricks wrote the draft and Dr Rothman revised the phentermine pharmacotherapy for obesity. Obesity (Silver Spring) 2011letter. Both authors agreed on the final draft and have no [Epub ahead of print].conflicts of interest. 5. Gadde KM, Allison DB, Ryan DH et al. Effects of low-dose, controlled- release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER):References a randomised, placebo-controlled, phase 3 trial. Lancet 2011; 377: 1341–1352.1. Kang JG, Park CY, Kang JH, Park YW, Park SW. Randomized controlled trial to 6. Colman E. Anorectics on trial: a half century of federal regulation of investigate the effects of a newly developed formulation of phentermine prescription appetite suppressants. Ann Intern Med 2005; 143: 380–385. diffuse-controlled release for obesity. Diabetes Obes Metab 2010; 12: 876–882. 7. Weintraub M. Long-term weight control study: conclusions. Clin Pharmacol Ther 1992; 51: 642–646.2. Aucott L, Rothnie H, McIntyre L, Thapa M, Waweru C, Gray D. Long-term weight loss from lifestyle intervention benefits blood pressure? a systematic 8. Craddock D. Anorectic drugs: use in general practice. Drugs 1976; 11: review. Hypertension 2009; 54: 756–762. 378–393.3. Rothman RB. Treatment of obesity with ‘‘combination’’ pharmacotherapy. 9. Hendricks EJ, Rothman RB, Greenway FL. How physician obesity specialists Am J Ther 2010; 17: 596–603. use drugs to treat obesity. Obesity 2009; 17: 1730–1735.964 doi:10.1111/j.1463-1326.2011.01435.x Volume 13 No. 10 October 2011