ACE and obesity due to melanocortin 4 receptor deficiency: Hypertension with obesity is prevalent in Japanese population, which is crucial health problems since both hypertension and obesity are risk factors for cardiovascular events.[1,2] A current guideline for hypertension (JSH2014) recommends prescribing angiotensin-converting enzyme (ACE)-inhibitors or angiotensin receptor blockers (ARBs), followed by thiazide diuretics.[3] However, it is well known that thiazide diuretics have unfavorable effects in glucose metabolism.