The patient was a 44-year-old woman who had been obese for 20 years (height, 5'3"; weight, 194.8 lb; body mass index, 32.7 kg/m²; waistline, 42"). She had had hypertension for 5 years and diabetes mellitus for 3 years. After embarking on 6 ineffective diets, she continued to gain weight. Sibutramine 10 mg/d (Meridia) was prescribed for 4 months. Her weight decreased from 201.9 to 189.8 lb. Her blood pressure decreased from 148/88 mm Hg to 142/85 mm Hg while taking 100 mg of metoprolol (Lopressor; Toprol XL); her heart rate was 78 beats/min. Her blood glucose level while taking 1.000 mg of metformin (Fortamet; Glucophage; Riomet) was 130 mg/dL and her glycosylated hemoglobin (A1C) decreased from 7.2% to 7.1%. Her high-density lipoprotein and lowdensity lipoprotein cholesterol levels did not change.

The patient's body weight and blood pressure slowly increased again. Six months after the initial sibutramine prescription, her weight reached 194.8 lb, and her blood pressure was 160/94 mm Hg. Her antihypertensive medication was changed to a combination of the nondihydropyridine calcium channel antagonist verapamil (Calan, Covera, Isoptin, Verelan) 180 mg plus the angiotensin-converting enzyme (ACE) inhibitor trandolapril (Mavik) 2 mg, resulting in a decrease in blood pressure to 140/86 mm Hg; her heart rate was 79 beats/min, and her fasting blood glucose levels decreased from 138 mg% to 129 mg/dL. Her A1C decreased from 7.3% to 7.1%.

After 6 weeks, the patient was started on 15 mg/d of sibutramine again, and she continued to follow diet and exercise recommendations. After 5 months, the patient's weight decreased to 181 lb, her waistline decreased to 39.6", her blood pressure was normal (128/80 mm Hg), her heart rate was 82 beats/min, her fasting glucose level was 108 mg/dL and her A1C was 6.5%. After changing her antihypertensive treatment to a combination of an ACE inhibitor and calcium channel blocker and continuing the sibutramine, the patient's hypertension and diabetes mellitus improved dramatically.