AHA-BP: Weight Loss Can Normalize Blood Pressure

October 1, 2007

TUCSON, Ariz. -- At least half of overweight patients with stage I hypertension can normalize their blood pressure with modest weight loss, Italian investigators reported here.

TUCSON, Ariz., Oct. 1 -- At least half of overweight patients with stage I hypertension can normalize their blood pressure with modest weight loss, Italian investigators reported here.

After six months on a reduced-calorie diet, supplemented by a lipase inhibitor in some cases, about half of 210 patients lost more than 5% of their body weight, which was associated with about a 5% reduction in blood pressure, Roberto Fogari, M.D., of the University of Pavia, reported at a conference of the American Heart Association's Council for High Blood Pressure Research.

The results demonstrated not only that weight loss alone can normalize hypertension but also that many overweight hypertensive patients have been misdiagnosed as having essential hypertension. The results emphasize the importance of initiating dietary intervention in overweight patients with high blood pressure before resorting to drug treatment, said Dr. Fogari.

"This is important because it means that in these patients with elevated blood pressure who were overweight, the blood pressure is not a form of essential hypertension but was hypertension secondary to body weight," said Dr. Fogari.

"These findings apply to western societies in general, but only to overweight patients, not to obese patients, with high blood pressure," he added.

The study involved men and men and women ages 29 to 65 and who had a body mass index of 25 to 29 kg/m2, defining them as overweight but not obese. All the patients had stage I hypertension, reflected in a systolic blood pressure of 140 to 159 mm Hg and a diastolic pressure of 90 to 99 mm Hg. None of the patients had a history of antihypertensive therapy.

Upon entry to the study, each patient consulted with dietary authorities who developed individualized reduced-calorie food plans that reflected a patient's food preferences. About half the patients also received the lipase inhibitor orilistat (Xenical) as an aid to weight loss and weight maintenance.

"We gave orilistat only when diet alone was not able to achieve the appropriate reduction in body weight," said Dr. Fogari.

After six months of follow-up, 49% of the women and 53% of the men had lost more than 5% of the baseline bodyweight. The 5% reduction in blood pressure that accompanied the weight loss was sufficient to normalize blood pressure in many patients.

There was a significant reduction in plasma leptin (from 17.34.4 to 10.93.2 ng/mL, P