BACKGROUND: All major guidelines on antihypertensive therapy recommend weight 
loss; anti-obesity drugs may be able to help in this respect.
PRIMARY OBJECTIVES: To assess the long-term effects of pharmacologically induced 
reduction in body weight in adults with essential hypertension on all-cause 
mortality, cardiovascular morbidity, and adverse events (including total serious 
adverse events, withdrawal due to adverse events, and total non-serious adverse 
events).
SECONDARY OBJECTIVES: To assess the long-term effects of pharmacologically 
induced reduction in body weight in adults with essential hypertension on change 
from baseline in systolic blood pressure, change from baseline in diastolic 
blood pressure, and body weight reduction.
SEARCH METHODS: We obtained studies using computerised searches of the Cochrane 
Hypertension Group Specialised Register, the Cochrane Central Register of 
Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid EMBASE, the clinical trials 
registry ClinicalTrials.gov, and from handsearches in reference lists and 
systematic reviews (status as of 13 April 2015).
SELECTION CRITERIA: Randomised controlled trials in hypertensive adults of at 
least 24 weeks' duration that compared long-term pharmacologic interventions for 
weight loss with placebo. 
DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, 
assessed risk of bias, and extracted data. Where appropriate and in the absence 
of significant heterogeneity between studies (P > 0.1), we pooled studies using 
fixed-effect meta-analysis. When heterogeneity was present, we used the 
random-effects method and investigated the cause of heterogeneity.
MAIN RESULTS: After updating the literature search, which was extended to 
include four new weight-reducing drugs, we identified one additional study of 
phentermine/topiramate, bringing the total number of studies to nine that 
compare orlistat, sibutramine, or phentermine/topiramate to placebo and thus 
fulfil our inclusion criteria. We identified no relevant studies investigating 
rimonabant, liraglutide, lorcaserin, or naltrexone/bupropion. No study included 
mortality and cardiovascular morbidity as predefined outcomes. Incidence of 
gastrointestinal side effects was consistently higher in those participants 
treated with orlistat versus those treated with placebo. The most frequent side 
effects were dry mouth, constipation, and headache with sibutramine, and dry 
mouth and paresthaesia with phentermine/topiramate. In participants assigned to 
orlistat, sibutramine, or phentermine/topiramate body weight was reduced more 
effectively than in participants in the usual-care/placebo groups. Orlistat 
reduced systolic blood pressure as compared to placebo by -2.5 mm Hg (mean 
difference (MD); 95% confidence interval (CI): -4.0 to -0.9 mm Hg) and diastolic 
blood pressure by -1.9 mm Hg (MD; 95% CI: -3.0 to -0.9 mm Hg). Sibutramine 
increased diastolic blood pressure compared to placebo by +3.2 mm Hg (MD; 95% 
CI: +1.4 to +4.9 mm Hg). The one trial that investigated phentermine/topiramate 
suggested it lowered blood pressure.
AUTHORS' CONCLUSIONS: In people with elevated blood pressure, orlistat and 
sibutramine reduced body weight to a similar degree, while 
phentermine/topiramate reduced body weight to a greater extent. In the same 
trials, orlistat and phentermine/topiramate reduced blood pressure, while 
sibutramine increased it. We could include no trials investigating rimonabant, 
liraglutide, lorcaserin, or naltrexone/bupropion in people with elevated blood 
pressure. Long-term trials assessing the effect of orlistat, liraglutide, 
lorcaserin, phentermine/topiramate, or naltrexone/bupropion on mortality and 
morbidity are unavailable and needed. Rimonabant and sibutramine have been 
withdrawn from the market, after long-term trials on mortality and morbidity 
have confirmed concerns about the potential severe side effects of these two 
drugs. The European Medicines Agency refused marketing authorisation for 
phentermine/topiramate due to safety concerns, while the application for 
European marketing authorisation for lorcaserin was withdrawn by the 
manufacturer after the Committee for Medicinal Products for Human Use judged the 
overall benefit/risk balance to be negative.