Current guidelines for the management of hypertension and dyslipidemia have focused on the need to set blood pressure (BP) and lipid targets dependent upon a patient's overall level of CV risk. [4][5][6][7][8] However, despite the high prevalence of concomitant hypertension and dyslipidemia, observational data suggest that fewer than 10% of patients attain recommended therapeutic targets for both conditions.9 Treatment strategies that specifically target overall CV risk rather than individual risk factors are therefore warranted.Amlodipine besylate is a dihydropyridine calcium channel blocker (CCB) approved for the treatment of hypertension and both vasospastic and chronic, stable angina.10 Amlodipine is well tolerated and efficacious at lowering BP. The largest clinical hypertension trial to date, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT [n=33,357]), 11 reinforced

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LUTES. Combined drug treatmet of obesity. Obes Res.Pharmacologicaltreatment of obesity has beenneglected as aviable therapeuticoption formany years. Recent long term studies with combinations of obesity drugs gives promise that drugs may play a role in weight maintenance, which classically has been the most difficult aspect of treating obesity. Currently available obesity drugs include centrally acting adrenergic agents and serotonin agonists. Drugs stillin development include alipaseinhibitorthat produces fat malabsorption, a combined adrenergic-serotonergic reuptake inhibitor, various gut-central nervous system peptides, and a number of beta-3 agonists. Any of these obesity drugs given alone produces modestweight loss,and formost,weight loss continuesfor as long as medication is given. The most successful drug regimens to date are combinations of phentermineandfenfluramineorof ephedrine, caffeine, and/or aspirin. The former combination produces reduction in body weight and complications of obesityfor2 to almost4 yearsinclinicaltrials to date. More research is needed to document long term efficacy and particularly the long term safety of these and other combinations.1995;3(S~ppl4):497S-5OOS.

ATKINSON, RICHARD L, ROY C BLANK, DONALD LAS L RITCH. Long-term drug treatment of obesity in a private practice setting. Obes Res. 1997;5:57&586. This study evaluated the long-term efficacy and safety of the combination of phentermine and fenfluramine for the treatment of obesity in a private practice setting. A total of 1388 consecutive, qualified patients presenting to a private general internal medicine practice in Charlotte, NC, were enrolled with eligibility criteria including: age 18 years to 60 years, 20% over "desirable" bodyweight or body mass index >27, no serious medical or psychiatric disease, and no contraindications to drug therapy. Patients were instructed in diet, exercise, and behavior modification techniques and received phentermine (15 mg/day to 30 mg/day) and fenfluramine (20 mg/day to 60 mg/day) continuously for over 3 years. Average duration of treatment was 15.9 months, and average weight loss at the last visit was 11.6 kg, or 11.7% of initial bodyweight. For patients completing 1 year of drug treatment, mean weight loss was 16.5 kg, or 16% of initial weight. Weight loss persisted for 2 years, but partial regain was seen at 3 years. The dropout rates were 18% at 6 months, 39% at 1 year, 68% at 2 years, and 78% at 3 years. At 1 year, blood pressure of hypertensive patients fell from 151/95 mm Hg to 127/78 mm Hg, and serum cholesterol and triglycerides of hyperlipidemic patients fell by 0.750 mmoVL (29 mg/dL) and 0.937 mmoVL (83 mg/dL), respectively. Adverse events were SCHUMACHER, NIKHIL V DHURANDHAR, DOUG- modest. We conclude that, in a private practice setting, long-term treatment of obesity with the combination of phentermine, fenfluramine, and a weight maintenance program is generally safe and effective. More research is needed to determine efficacy and safety for longer than 3 years.