4. Discussion
This is the first report, to the best of our knowledge, suggesting that integrative medicine which is defined as a combination therapy of oriental medicine and western medicine (in this case, BOF add-on therapy) is able to exert greater beneficial effects than conventional western therapy alone, based on “out-of-clinic” ambulatory BP profile (i.e. ambulatory BP variability) in hypertensive patients with obesity (Table 2). In the present study, it was demonstrated that the BOF add-on therapy, compared with the conventional therapy, significantly improved short-term BP variability on ambulatory BP monitoring (Table 2), in addition to an anti-obesity effect (reduction in both body weight and BMI) (Table 3). Furthermore, on multivariate analysis, BOF usage was independently associated with the improvement in ambulatory BP variability, in spite of there being no significant relationship to the changes in the BP level or BMI (Table 5). These results suggest that, in obesity-related hypertension, BOF may exert a beneficial effect on short-term BP variability that is independent of the reductions in body weight and/or average BP level. Previous studies have shown that the average BP level is the primary BP-related risk factor for CVD and an appropriate BP reduction is essential to both prevent target organ damage and reduce cardiovascular mortality in cases of hypertension [22]. With respect to direct BP lowering capacity of BOF, since the medication status of the antihypertensive agents used was comparable in the two treatment groups during the entire treatment period and antihypertensive agents were increased similarly in both groups to achieve the target clinic BP level (Supplemental Table 2), the direct effect of BOF on average BP lowering may be weak.