Abstract-Current guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommend first-line treatment with a thiazide diuretic but do not provide specific guidance for obese patients. The renin system is activated in obesity-associated arterial hypertension. Therefore, we tested the hypothesis that the oral direct renin inhibitor aliskiren could provide additive blood pressure lowering in obese patients with hypertension (body mass index Ն30 kg/m 2 ; mean sitting diastolic blood pressure: 95 to 109 mm Hg) who had not responded to 4 weeks of treatment with hydrochlorothiazide (HCTZ) 25 mg. After a 2-to 4-week washout, 560 patients received single-blind HCTZ (25 mg) for 4 weeks; 489 nonresponders were randomly assigned to double-blind aliskiren (150 mg), irbesartan (150 mg), amlodipine (5 mg), or placebo for 4 weeks added to HCTZ (25 mg), followed by 8 weeks on double the initial doses of aliskiren, irbesartan, or amlodipine. After 8 weeks of double-blind treatment (4 weeks on the higher dose), aliskiren/HCTZ lowered blood pressure by 15.8/11.9 mm Hg, significantly more (PϽ0.0001) than placebo/HCTZ (8.6/7.9 mm Hg). Aliskiren/HCTZ provided blood pressure reductions similar to those with irbesartan/ HCTZ and amlodipine/HCTZ (15.4/11.3 and 13.6/10.3 mm Hg, respectively), with similar tolerability to placebo/ HCTZ. Adverse event rates were highest with amlodipine/HCTZ because of a higher incidence of peripheral edema (11.1% versus 0.8% to 1.6% in other groups). In conclusion, combination treatment with aliskiren is a highly effective and well-tolerated therapeutic option for obese patients with hypertension who fail to achieve blood pressure control with first-line thiazide diuretic treatment. Key Words: direct renin inhibitor Ⅲ Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 Ⅲ obesity Ⅲ renin-angiotensin system Ⅲ thiazide diuretic T he proportion of hypertensive patients who are obese has increased steadily in recent years. Given that 75% of obese patients have hypertension, but Ͻ20% have their blood pressure (BP) controlled to Ͻ140/90 mm Hg, 1 there is a clear need for new antihypertensive treatment options for this patient group. Yet, current guidelines do not provide specific guidance for the treatment of this patient population, 2 and data from larger clinical trials addressing the issue are lacking. This state of affairs is surprising, because the underlying pathophysiology differs between lean and obese patients with arterial hypertension. In particular, obesityassociated hypertension involves activation of the renin system, 3,4 volume expansion, and increased cardiac output 5-7 rather than systemic vasoconstriction. Combination of a low dose of a thiazide diuretic with a renin system inhibitor may, therefore, be a suitable treatment approach. 8 Aliskiren is the first in a new class of direct renin inhibitors. 9,10 Combination treatment with a renin system inhibitor is a theoretically attracti...

Heat stable protease isolated from the sarcoplasmic fraction of menhaden (Brevoorti tyrannus) muscle tissue was characterized as to optimum temperature and pH against casein substrate and its degradative action on actomyosin and surimi during heating. The optimum conditions for activity were 60°C at a pH of 7.5 to 8.0. Activity dropped off remarkably at temperatures below 45°C or above 70°C and when pH was below 7.0 or above 8.0. The enzyme(s) was capable of degrading actomyosin as observed by sodium dodecyl sulfate electrophoresis. This implicated a causative role for this protease system in the texture degradation observed during thermal processing of menhaden surimi at temperatures of .50-70°C.

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Blood pressure control in class 3 obesity was less likely to be achieved with hydrochlorothiazide monotherapy. While addition of amlodipine, irbesartan, or aliskiren to hydrochlorothiazide improved the blood pressure response, amlodipine was less effective and induced peripheral edema in 19% of patients with class 3 obesity.