Weight Loss and Reduction of Blood Pressure and Hypertension

Abstract

The article in the current issue of Hypertension by Aucott et al1 raises some interesting questions. Does weight loss in the long term (ie, >3 years) result in a decrease in blood pressure (BP) levels? Is there difference in the effect of weight loss on decreased systolic BP (SBP) versus diastolic BP (DBP)? They combined 8 clinical trials and 8 cohort studies and tried to evaluate the linear relationship between change in BP and weight change. Overall, there was only a 2.8-kg weight loss, which resulted in a 1.9-mm decrease in DBP and 2.9 mm for SBP, neither of which were significant. Most important, the association between decrease in SBP with weight loss dissipated substantially over time (that is, >3 years from the onset of the study). The conclusion is that in long term, weight loss had little effect on change in BP levels. Weight loss has been a recommended nonpharmacological therapy for reducing BP levels for many years. Before the introduction of effective antihypertensive drug therapy, reduction of salt in the diet, weight loss, and mild sedation were recommended therapies for patients with nonmalignant hypertension.2 Previous meta-analyses of clinical trials on the effects of weight reduction on BP concluded that weight loss is important in both the prevention and treatment of hypertension.3 Most of the studies in the meta-analysis had relatively small sample sizes and short duration, usually <1 year. Is there really no health benefit of weight loss with decreased BP in the long term? To test such a hypothesis, participants would have to lose a substantial amount of weight (ie, >10 kg), have good BP measures before and after weight loss, a comparison group without substantial weight loss but having similar diet except for the differences in caloric intake or energy expenditure (ie, physical …