Weight Loss and Blood Pressure Control (Pro)

Abstract

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 ...

Genetic and environmental influences on blood pressure and body mass index in Han Chinese: a twin study

“…Obesity is a well-established risk factor for hypertension. [2][3][4] Twin studies have shown that underlying continuous traits for both hypertension and obesity are significantly heritable. Heritability estimates for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) are between 40 and 60%, 5 and the heritability for body mass index (BMI) is also substantial.…”

Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes

“…29 For the LDL cohort, we used a reduction in LDL-C of ≥10 %, 30 and for the SBP cohort we used a reduction in SBP ≥5.5 mm Hg. 31 Medication adherence was calculated for oral glucoselowering medications, antihypertensives, and lipid-lowering agents within the HbA1c, SBP, and LDL-C cohorts, respectively, and was measured using dispensing data from the 12-month period immediately preceding the patient's follow-up test date. We estimated a continuous multiple-interval measure of medication refill adherence (MRA) 32,33 as the days' supply dispensed during the 12-month period divided by the number of days of observation with evidence of a dispensing.…”

Increase in Treatment-Refractory Hypertension: Progress in Current Treatment by Primary Care

“…Less common causes of TRH include aortic coarctation, Cushing's disease, glucocorticoid remediable aldosteronism, hyperparathyroidism, intracranial tumor, and pheochromocytoma. 1,16 Secondary causes of TRH and screening tests were summarized previously. 1,17 Step 6.…”

“…Loop diuretics can be useful in controlling volume and lowering BP when kidney disease is advanced. 1,16 While debated, evidence suggests that renin-guided therapeutics improves BP control in TRH. 47,48 In a study from our group, BP fell more when clinical hypertension specialists knew the plasma renin activity (29/14) than when they did not (19/11), although only the difference in systolic BP was statistically significant.…”