Weight Loss Can Normalize Blood Pressure

AHA-BP: Weight Loss Can Normalize Blood Pressure

By Charles Bankhead, Staff Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.October 01, 2007


MedPage Today Action Points


Explain to interested patients that weight loss alone may help lower blood pressure to normal levels in some overweight individuals with stage I hypertension.

The results were reported at a medical conference and as a published abstract and should be considered preliminary until published in a peer-reviewed journal.

Review

TUCSON, Ariz., Oct. 1 -- At least half of overweight patients with stage I hypertension can normalize their blood pressure with modest weight loss, Italian investigators reported here.

After six months on a reduced-calorie diet, supplemented by a lipase inhibitor in some cases, about half of 210 patients lost more than 5% of their body weight, which was associated with about a 5% reduction in blood pressure, Roberto Fogari, M.D., of the University of Pavia, reported at a conference of the American Heart Association's Council for High Blood Pressure Research.

The results demonstrated not only that weight loss alone can normalize hypertension but also that many overweight hypertensive patients have been misdiagnosed as having essential hypertension. The results emphasize the importance of initiating dietary intervention in overweight patients with high blood pressure before resorting to drug treatment, said Dr. Fogari.

"This is important because it means that in these patients with elevated blood pressure who were overweight, the blood pressure is not a form of essential hypertension but was hypertension secondary to body weight," said Dr. Fogari.

"These findings apply to western societies in general, but only to overweight patients, not to obese patients, with high blood pressure," he added.

The study involved men and women ages 29 to 65 and who had a body mass index of 25 to 29 kg/m2, defining them as overweight but not obese. All the patients had stage I hypertension, reflected in a systolic blood pressure of 140 to 159 mm Hg and a diastolic pressure of 90 to 99 mm Hg. None of the patients had a history of antihypertensive therapy.

Upon entry to the study, each patient consulted with dietary authorities who developed individualized reduced-calorie food plans that reflected a patient's food preferences. About half the patients also received the lipase inhibitor orilistat (Xenical) as an aid to weight loss and weight maintenance.

"We gave orilistat only when diet alone was not able to achieve the appropriate reduction in body weight," said Dr. Fogari.

After six months of follow-up, 49% of the women and 53% of the men had lost more than 5% of the baseline bodyweight. The 5% reduction in blood pressure that accompanied the weight loss was sufficient to normalize blood pressure in many patients.

There was a significant reduction in plasma leptin (from 17.3±4.4 to 10.9±3.2 ng/mL, P<0.01), active renin (from 12.9±6.8 to 9.1±5.2 pg/mL P<0.05), and aldosterone (from 71.8±28.4 to 59.7±23.5 P<0.01).

Forty-eight percent of the those with bodyweight loss of 5% or more achieved a normal BMI (< 25 Kg/m2) and 53% showed a BP blood pressure normalization (< 140/90 mmHg). Plasma leptin, active renin and aldosterone decreases were not different than those of the 25 patients who did not achieve the blood pressure normalization despite the BMI normalization.

The study will continue until all patients have been followed for a year.

Primary source: American Heart Association's 61st Annual Fall Conference of the Council on High Blood Pressure Research

Source reference:

Fogari R et al. "Effect of body weight loss on blood pressure in stage I hypertensive overweight patients. American Heart Association's 61st Fall Conference of the Council on High Blood Pressure Research, 2007. Abstract P213.