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To the Editor: The prevalence of obesity is increasing in elderly persons as well as in the general population, and excess body weight adversely affects cardiovascular risk factors, including hypertension, in this population.¹ Nevertheless, Dr Chaudhry and colleagues² did not list obesity as an identifiable cause of hypertension in their treatment algorithm for systolic hypertension in older persons. This oversight is in line with the common failure by physicians to recognize obesity as an identifiable cause of hypertension as well as a condition requiring additional workup (such as assessment of medication use, endocrine function, nutritional deficiencies, and treatable causes of immobility).³ While the efficacy of pharmacological treatment for obesity in elderly persons has not been established,⁴ surgical treatment of obesity has been shown to significantly improve cardiovascular risk factors, including hypertension, even in elderly individuals.⁵ Obesity should be considered a medical condition requiring proper medical management in its own right.³

Arya M. Sharma, MD, FRCPC
sharma@ccc.mcmaster.ca
Department of Medicine
McMaster University
Hamilton, Ontario

1. Kennedy RL, Chokkalingham K, Srinivasan R. Obesity in the elderly: who should we be treating, and why, and how? Curr Opin Clin Nutr Metab Care. 2004;7:3-9. FULL TEXT | ISI | PUBMED 2. Chaudhry SI, Krumholz HM, Foody JM. Systolic hypertension in older persons. JAMA. 2004;292:1074-1080. FREE FULL TEXT 3. Bramlage P, Wittchen HU, Pittrow D, et al. Recognition and management of overweight and obesity in primary care in Germany. Int J Obes Relat Metab Disord. 2004;28:1299-1308. FULL TEXT | ISI | PUBMED 4. Dvorak R, Starling RD, Calles-Escandon J, Sims EA, Poehlman ET. Drug therapy for obesity in the elderly. Drugs Aging. 1997;11:338-351. PUBMED 5. Sugerman HJ, DeMaria EJ, Kellum JM, Sugerman EL, Meador JG, Wolfe LG. Effects of bariatric surgery in older patients. Ann Surg. 2004;240:243-247. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292:2465-2466.

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