Blood pressure control during weight reduction in obese hypertensive men: separate effects of sodium and energy restriction.

Fagerberg, Björn; Ok, Andersson; Isaksson, B; Björntorp, Per

doi:10.1136/bmj.288.6410.11

Cited by 107 publications

(39 citation statements)

References 22 publications

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“…An early study, Dahl et al 38 found sodium restriction in low calorie diets to be the primary cause of blood pressure reduction. This is also the finding of Fagerberg et al 39 Several more recent studies have sided with weight loss as having an independent effect on blood pressure reduction. Reisen et al 40 found blood pressure reductions on the order of 3 mm Hg for each kg of weight loss in a sample of hypertensive men with no sodium restriction.…”

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confidence: 68%

Weight Loss and Blood Pressure Control (Pro)

2008

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O verweight is an increasingly prevalent condition throughout the world. Current estimates, which are probably conservative, indicate that at least 500 000 000 people worldwide are overweight as defined by a body mass index (BMI) of between 25.0 and 29.9 and an additional 250 000 000 are obese with a BMI of 30.0 or higher. 1 In the United States, recent data indicate that as much as 66% of the adult population is overweight or obese. 2 Overweight and obesity are established risk factors for cardiovascular disease (CVD), stroke, noninsulin dependent diabetes (NIDDM), certain cancers, and numerous other disorders. 3,4,5,6,7 It is also a risk factor for hypertension. 8 Hypertension, defined as a systolic blood pressure in excess of 140 mm Hg or a diastolic blood pressure higher than 90 mm Hg, is also a globally increasing public health concern. Roughly 1 billion individuals worldwide are estimated to exhibit clinically significant elevated blood pressure with about 50 million of those residing in the United States. 8 Hypertension, in turn, is associated with increased risk for CVD, stroke, renal disease, and all-cause mortality. 9,10,11,12 The JNC VII report defines Stage 1 hypertension as blood pressure levels between 140 and 159 mm Hg systolic and 90 and 99 diastolic. Additionally, the report establishes a category of Prehypertension (Systolic blood pressure between 120 and 140 mm Hg or diastolic between 80 and 89 mm Hg). These 2 blood pressure classifications are deemed to be appropriate primary targets for lifestyle modification interventions, including weight loss. Higher levels of blood pressure, or stage 1 hypertension that is maintained over a long period, should be addressed primarily with medications or other physician directed treatments.There is a positive relationship between overweight or obesity and blood pressure and risk for hypertension. As early as the 1920s, a significant association between body weight and blood pressure was noted in men. 13,14 In the intervening years, epidemiological studies have routinely confirmed this association. The Framingham Study found that hypertension is about twice as prevalent in the obese as the nonobese of both sexes. 15 Stamler and colleagues 16 noted an odds ratio for hypertension of obese relative to nonobese (BMI of less than 25) of 2.42 for younger adults and 1.54 for older ones. The Nurses Health Study 17 compared women with BMIs of less than 22 with those above 29 and found a 2-to 6-fold greater prevalence of hypertension among the obese.More recent data from the Framingham Study further support this relationship. Divided into BMI quintiles, Framingham participants of both sexes demonstrated increasing blood pressures with increased overweight. In this instance those in the highest BMI quintile exhibited 16 mm Hg higher systolic and 9 mm Hg higher diastolic blood pressures than those in the lowest quintile. For systolic blood pressure this translated into an increase of 4 mm Hg for each 4.5 kg of increased weight. 18 In younger Canadian adults, Rabkin et ...

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confidence: 68%

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2008

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“…4 However, contradictory to the results of the latter study, Reisin and coworkers 5 demonstrated a fall in blood pressure in patients with only a moderately negative energy balance independent of sodium intake. Our data are in agreement with the findings of Reisin et al 5 since a mild calorie restriction (about 6,300 kJ/24 hr) leads to a significant blood pressure decrease in spite of an unchanged sodium balance.…”

Section: Effects Of Long-term Energy Restrictionmentioning

confidence: 80%

“…However, our results do not exclude the possibility of an additive effect of sodium restriction superimposed on a negative energy balance. 4 As mentioned above, reduced intravascular fluid volume may contribute to the fall in blood pressure during severe short-term energy restriction. 31 However, several reports 42 -44 indicate that also after long-term negative energy balance, weight loss re-suits in a contracted blood volume, leading to a decreased cardiac output and lowered blood pressure.…”

Section: Effects Of Long-term Energy Restrictionmentioning

confidence: 97%

Effect of energy-restricted diet on sympathetic muscle nerve activity in obese women.

et al. 1991

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Twenty obese women aged 45-65 years with borderline hypertension were allocated randomly to either a group with an energy-restricted diet or to a control group. Body weight, blood pressure, urinary sodium, and urinary excretion of norepinephrine and plasma volume were recorded. Resting muscle sympathetic nerve activity was measured in the peroneal nerve by tungsten microelectrodes and expressed as bursts per minute. These measurements were repeated after 3 days of semistarvation and after a body weight reduction of 7% while each patient's weight was in a steady state. After 3 days of semistarvation, only body weight was reduced, whereas after the long-term energy intake restriction, there were reductions of body weight (79.9±3.4 versus 74.1±3.4 kg;p<0.001), diastolic blood pressure (93+3 versus 86±4 mm Hg; p=0.01), and muscle sympathetic nerve activity (49±2 versus 42±3 bursts/min; p<0.05). Other variables were unchanged. There were no changes in body weight, blood pressure, or muscle sympathetic nerve activity in the control group. We conclude that body weight decrease in obesity results in a reduction of blood pressure that is at least partially caused by a reduction of sympathetic vasoconstrictor activity. (Hypertension 1991;18:783-789) M any studies have shown that a decrease in body weight in hypertensive patients with moderate-to-severe obesity is associated with a fall in blood pressure. 1 -2 The mechanisms behind the blood pressure reduction are only partially understood. Some authors have suggested that a restricted sodium intake 34 contributes to the blood pressure decrement; others have found a fall in blood pressure without a concomitant decrease of sodium intake.5 Based on measurements of circulating norepinephrine concentrations, it has also been proposed that both the acute and the long-term reduction of blood pressure are due to a reduced sympathetic vasoconstrictor drive. In a previous study 13 of obese borderline hypertensive women who had been fasting for 48 hours, we made direct recordings of sympathetic neural outflow to the vascular bed of skeletal muscle and found an essentially unchanged nerve traffic in spite of a significant blood pressure reduction. The patients were energy and sodium restricted. It has been suggested previously 1415 that salt and energy intake restriction have opposite effects on sympathetic nervous activity so that the net effect of a markedly reduced sodium intake combined with a negative energy balance may be no change or even an increased sympathetic drive (expressed as increased levels of plasma norepinephrine). Our previous results are compatible with this hypothesis.The aim of the present study was to clarify the effect of calorie restriction on sympathetic nerve activity by measuring efferent muscle sympathetic activity in a group of obese and borderline hypertensive women before and after a short-term sodiumsupplemented period of fasting and also to assess the effects of a long-term negative energy balance on plasma volume, blood pressure, and efferent vasoco...

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“…Weight gain has been associated with increases in BP, and correspondingly, weight loss often results in decreased BP (25,32). Some studies suggest that obese individuals may be more sensitive to the effects of sodium on BP than nonobese individuals (46,76).…”

Section: Ci: Confidence Intervalmentioning

confidence: 99%

Sodium Intake and Cardiovascular Disease

Morrison

Ness

2011

Annu. Rev. Public Health

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Sodium consumption is a target for prevention of cardiovascular disease (CVD). The relationship between sodium intake and blood pressure (BP) is well-established, but the relationship with CVD is less clear. This review focuses on studies investigating the association between sodium intake and CVD within five principal subgroups: age, underlying BP, gender, body size, and ethnicity. We conclude that sodium reduction results in decreased CVD risk in the general population, and some susceptible subgroups may especially benefit from preventive efforts. Older individuals, those with underlying elevated BP, and those with increased body size may benefit most, but men and women of all ages, ethnicities, and normotensives also experience reduced CVD risk in relation to lowered sodium intake. Public health policy to reduce sodium intake in the United States would have significant cost-savings, far greater than the cost of intervention, and would also result in a significant gain in quality-adjusted life years.

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Blood pressure control during weight reduction in obese hypertensive men: separate effects of sodium and energy restriction.

Cited by 107 publications

References 22 publications

Weight Loss and Blood Pressure Control (Pro)

Weight Loss and Blood Pressure Control (Pro)

Effect of energy-restricted diet on sympathetic muscle nerve activity in obese women.

Sodium Intake and Cardiovascular Disease

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