Clinical Case Scenario – Obesity & Antihypertensive Choice
Clinical Case Scenario – Obesity & Antihypertensive Choice
A 54-year-old man with BMI 34 kg/m² presents with newly diagnosed hypertension (150/94 mm Hg).
He has prediabetes and is motivated to lose weight. He expresses concern about medications that might make weight loss more difficult.
You are selecting first-line pharmacologic therapy.
Which antihypertensive drug class includes agents known to promote weight gain?
A) ACE inhibitors
B) ARBs
C) Beta blockers
D) Calcium channel blockers
Correct Answer: C) Beta blockers
• Older beta-blockers (e.g., atenolol, metoprolol) may be associated with modest weight gain and less favorable metabolic effects.
• Vasodilating beta-blockers (e.g., carvedilol, nebivolol) demonstrate a more favorable metabolic profile and appear relatively weight-neutral.
• Beta-blockers remain appropriate when there is a compelling indication (e.g., CAD, heart failure, arrhythmia).
References
• ESC/ESH 2024 Hypertension Guidelines
• Medscape – Fast Five Quiz: Obesity-Related Hypertension
Published February 19, 2026. Accessed February 26, 2026.