Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association

Abstract

Hypertension is a major risk factor for cardiovascular and renal diseases in the United States and worldwide. Obesity accounts for much of the risk for primary hypertension through several mechanisms, including neurohormonal activation, inflammation, and kidney dysfunction. As the prevalence of obesity continues to increase, hypertension and associated cardiorenal diseases will also increase unless more effective strategies to prevent and treat obesity are developed. Lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited. Effective pharmacotherapeutic and procedural strategies, including metabolic surgeries, are additional options to treat obesity and prevent or attenuate obesity hypertension, target organ damage, and subsequent disease. Medications can be useful for short- and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity. Unanswered questions remain related to the mechanisms of obesity-related diseases, long-term efficacy of different treatment and prevention strategies, and timing of these interventions to prevent obesity and hypertension-mediated target organ damage. Further investigation, including randomized controlled trials, is essential to addressing these questions, and emphasis should be placed on the prevention of obesity to reduce the burden of hypertensive cardiovascular and kidney diseases and subsequent mortality.

Effects of Arterial Stiffness and Carotid Intima-Media Thickness Progression on the Risk of Overweight/Obesity and Elevated Blood Pressure/Hypertension: a Cross-Lagged Cohort Study

“…The absolute time in moderate to vigorous physical activity was a relatively small proportion of the day, although within the expected range. 13,22 Therefore, we additionally controlled for sedentary time and light physical activity but the findings remained unchanged. We cannot exclude unmeasured or residual confounders, for instance, adiponectin has been associated with arterial stiffness progression.…”

BMI and blood pressure control among United States adults with hypertension

“…Over 70% of United States adults are overweight or obese, defined by a BMI of 25 to less than 30 kg/m 2 or BMI at least 30 kg/m 2 , respectively [4]. Overweight and obesity increase the risk of developing hypertension through multiple pathophysiologic mechanisms [5][6][7] and the prevalence of hypertension increases at higher levels of BMI [8,9].…”

Development of a short-form Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) and its validation among hypertensive patients

“…Although there was a decrease of 1.2 grams compared to the results published in 2015, which was much higher than the maximum daily salt intake (6 g/d) recommended by "Dietary Guidelines for Chinese Residents" [19]. The World Health Organization's (WHO) Global Action Plan for the Prevention and Control on Noncommunicable Diseases (2013-2020) said that salt intake should be correspondingly reduced by 30 percent [20]. The study of China's Zhejiang Province is a population-based survey of 7512 residents, only 12.0% of participants once used or were currently using Salt-Restriction Spoons (SRS) [21].…”