Greg S.
Age 53
Height 6'1"
Weight 206 lbs
BP 144/94
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Stage 1 Hypertension, BMI 27
Profile and History:
Greg, 53, has stage 1 hypertension. His average BP is 144/94.
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He's 6'1", weighs 206 lbs and has a BMI of 27.
- He is currently taking enalapril, 5 mg bid.
- He's on a reduced-calorie diet and an increased-activity regimen.
- He is CEO of a Fortune 500 company.
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Diagnosis and Identification:
Greg has returned for his first follow-up appointment. His weight and his BMI have remained the same, and he is still hypertensive.
- The treatment plan to normalize his blood pressure and reduce his cardiovascular risk through diet and exercise is still appropriate. However, XENICAL would help Greg lose weight and may help him be more consistent with his modified diet.
- Re-evaluating his current diet plan and choosing one that is more appropriate for his business dining needs is a good strategy for improving compliance - and success.
More on identifying patients at risk
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Counseling:
- Greg indicates that he's been walking the golf course. However, he tells you that because his business requires that he routinely "wine and dine" clients, it's been difficult to maintain this low-calorie diet, although he has been making healthier food choices when he does dine out.
- Acknowledging Greg's efforts to increase his activity level and make healthier food choices is a positive approach.
- By being reminded that his weight loss in combination with the medications would be more effective in normalizing his blood pressure and thus in reducing his cardiovascular risk, Greg acknowledges the importance of losing even a modest amount of weight.
- By recommending that he drink less wine (or other alcohol) and continue to focus on lean food choices, you help Greg find practical ways to stick to his regimen.
- Greg seems motivated to keep working at a modified diet and is willing to back off on his alcohol consumption.
More on counseling your patient
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Treatment:
- Treatment goals for Greg include weight loss, normalized blood pressure and reduced cardiovascular risk. A prescription for XENICAL, a 2000-calorie per day diet and a follow-up visit in 6 weeks is an appropriate strategy.
- You also give him material about weight control and XENICAL, as well as recommend
that he enroll immediately in the XENICare® support
program.
More on treatment and management
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Follow-Up:
When Greg returns for his follow-up visit, he looks better and he seems more positive. Greg has lost 6 lbs. His BMI is down one unit (BMI now 26) and you're seeing the results you want to see with his blood pressure. He continues on XENICAL to reduce the risk of weight regain.
More on follow-up care
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Outcomes:
Population with Abnormal (Untreated) Risk Factors at Randomization
Weight Loss with XENICAL Plus Diet: Improved Blood Pressure
- In the population with abnormal blood pressure at baseline (systolic BP >140 mm Hg), the change in systolic blood pressure from randomization to 1 year was greater for patients on XENICAL plus diet (-10.89 mm Hg) than for patients on placebo plus diet (-5.07 mm Hg). Patients with diastolic blood pressure >90 mm Hg on XENICAL plus diet also had greater changes in diastolic blood pressure (-7.9 mm Hg) than those on placebo plus diet did (-5.5 mm Hg).
Population as a Whole
XENICAL Plus Diet: Successful Weight Loss
In clinical trials involving 1064 patients, 69% on XENICAL plus diet lost 3% or more of initial body weight within 3 months, with a mean loss of 13 lbs.18
The mean change in systolic blood pressure was -1.01 mm Hg for patients on XENICAL plus diet and +0.58 mm Hg for patients on placebo plus diet. The mean change in diastolic blood pressure was -1.19 mm Hg for patients on XENICAL plus diet and +0.46 mm Hg for patients on placebo plus diet.
In clinical trials, the overall mean weight loss from randomization to the end of 1 year in the intent-to-treat population was 13.4 lbs in patients treated with XENICAL plus diet versus 5.8 lbs in placebo-treated patients.
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The long-term effects of orlistat on morbidity and mortality associated with obesity have not been established.
The patient depicted here is fictitious and is intended to illustrate an obesity-related comorbidity for which a treatment regimen including XENICAL plus a reduced-calorie diet is appropriate.
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