Effect of body weight loss and normalization on blood pressure in overweight non-obese patients with stage 1 hypertension

Abstract

We evaluated the effects of body weight (BW) loss on blood pressure (BP) in overweight non-obese patients with stage 1 hypertension. We enrolled 376 overweight (body mass index (BMI) X25 and o30 kg m À2 ) stage 1 hypertensive patients in this prospective 12-month trial. Each patient received tailored, low caloric dietary advice. After 6 months, patients with a BW reduction o5% were excluded. Body weight, BMI, BP, fasting plasma glucose (FPG), fasting plasma insulin (FPI), leptin (pL), renin and aldosterone levels were evaluated at baseline and after 6 and 12 months. In 222 patients who completed the study, a mean weight reduction of 8.1 kg reduced systolic blood pressure (SBP) by 4.2 mm Hg and diastolic blood pressure (DBP) by 3.3 mm Hg (Po0.05), which was accompanied by a significant decrease in FPI, pL and aldosterone levels (Po0.05). Larger SBP/DBP reductions were observed in 106 patients with normalized BMI (À5/À4.5 mm Hg, Po0.01) compared with the 116 patients who did not become normalized (À3.3/À1.6 mm Hg). The former also presented with greater decreases in FPG, FPI, pL, renin and aldosterone levels. Of the 106 patients who had normalized BMI, 52 also had normalized BP. Clinical and metabolic characteristics of these patients were similar to those of the 56 patients who did not have normalized BP. In overweight, mild hypertensive patients, weight loss was effective in reducing BP and in reversing some endocrinologic alterations associated with being overweight. Half of the patients who had normalized BMI also had normalized BP, which could indicate that these patients essentially did not have a form of hypertension but that these effects were instead secondary to being overweight. Keywords: blood pressure; overweight; weight-loss INTRODUCTION Excessive body weight (BW), in particular abdominal obesity, increases the risk for cardiovascular disease, stroke, type 2 diabetes, hypertension, lipoprotein disorders, osteoarthritis, certain types of cancers and total mortality. 1-5 An escalating epidemic of overweight (body mass index (BMI) X25 and o30 kg m À2 ) and obesity (BMI 430 kg m À2 ), is affecting both industrialized and many developing countries in the world, and constitutes a major public health problem. 4,6,7 In particular, in the United States, the prevalence of obesity was estimated at 32% of the population. Being overweight was even more prevalent, representing 42% of men and 28% of women, of whom 34 and 39%, respectively, had high blood pressure (BP). 8,9 The coexistence of hypertension and excessive BW greatly enhances cardiovascular risk. 2,10 Recent recommendations suggest the use of stratification tables to calculate the percentage of increased cardiovascular risk in patients with hypertension and excess BW or obesity. 11 The mechanisms underlying hypertension in subjects with excessive BW

A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

“…Second, the fruits and vegetables group had increased urine K + excretion, consistent with increased dietary K + that is associated with BP reduction in individuals with hypertension (34). Third, the fruits and vegetables group lost more body weight than did the HCO 3 group, probably contributing to BP reduction (35).…”

Changes in serum aldosterone are associated with changes in obesity-related factors in normotensive overweight and obese young adults

“…Previous small or moderate sized studies have reported decreases in serum aldosterone or aldosterone excretion with modest weight loss in obese postmenopausal women 8 , young overweight/obese adults 5, 7 , middle-aged overweight/obese adults 9, 26 , and obese adults who submitted to very low calorie diets 5, 10 . Some studies have reported significant associations between reductions in circulating RAAS components and reductions in central adiposity 5, 8 or insulin resistance 5 during weight loss, though not all studies agree 7 .…”

Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy

“…18,19 In addition, reduced body weight (Table 3) with F þ V might also have contributed. 20 Furthermore, the greater Ualb decrease in CKD 2 than in CKD 1 group given F þ V was associated with greater Sys BP reduction in CKD 2 than in CKD 1 group given F þ V. Consequently, greater Sys BP reduction might have mediated the greater Ualb decrease in CKD 2 than in CKD 1 group given F þ V. Dietary Na þ reduction decreases Sys BP more in those patients with reduced than normal GFR, 21 and possibly explains greater Sys BP reduction in CKD 2 than in CKD 1.…”