Background: Though it is well known that weight loss tends to decrease blood pressure, the quantitative association between the magnitude of weight loss and the effect on the need for antihypertensive medications is not well studied. We analyzed this association among overweight and obese attendees at two outpatient weight management centers. Methods: Case records of patients with a body mass index >25 at baseline were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1,000 kcal/day deficit), a behavior modification plan, and a plan for increasing physical activity. Results: The study cohort consisted of 100 participants, and the mean follow-up period was 15 ± 3.5 months. Significant weight loss (12.2 ± 3.4 kg) and systolic/diastolic blood pressure reductions (9.1/6.3 mm Hg) were observed by study exit. For 5, 10, and 15% weight loss, respectively, 3, 39, and 39% of the patients achieved at least 1 discontinuation of any antihypertensive medication, and 8, 42, and 21 dose reductions were achieved. Dose reductions or discontinuations occurred in all classes of antihypertensive medications with similar magnitudes of weight loss. Conclusions: Intentional weight loss can potentially result in dose reductions/discontinuations of antihypertensive medications. Our results should be validated with data from larger randomized controlled studies and may help to inform the conduct of a systematic review of prior randomized controlled trials that contain data on medication changes accompanying weight loss.

Keywords:
Weight loss, Obesity, Hypertension, Blood pressure, Antihypertensive agents
1.
Flegal KM, Carroll MD, Kit BK, Ogden CL: Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 2012;307:491–497.
2.
Stamler R, Stamler J, Riedlinger WF, Algera G, Roberts RH: Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA 1978;240:1607–1610.
3.
Boe J, Humerfelt S, Wedervang G: The blood pressure in a population: blood pressure readings and height and weight determinations in the adult population of the city of Bergen. Acta Med Scand Suppl 1957;321:1–336.
4.
Kannel WB, Gordon T, Offutt D: Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study. Ann Intern Med 1969;71:89–105.
5.
Five-year findings of the hypertension detection and follow-up program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979;242:2562–2571.
6.
Five-year findings of the hypertension detection and follow-up program: II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979;242:2572–2577.
7.
The Australian therapeutic trial in mild hypertension: Report by the Management Committee. Lancet 1980;1:1261–1267.
8.
Salzano JV, Gunning RV, Mastopaulo TN, Tuttle WW: Effect of weight loss on blood pressure. J Am Diet Assoc 1958;34:1309–1312.
9.
Reisin E, Abel R, Modan M, Silverberg DS, Eliahou HE, Modan B: Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. N Engl J Med 1978;298:1–6.
10.
Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al: Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011;34:1481–1486.
11.
Jeffrey SF, Eleftheria MF: Obesity; in Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (eds): Harrison’s Principles of Internal Medicine, ed 16. New York, McGraw Hill Inc, 2005, vol 1, pp 422–423.
12.
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults: Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–2497.
13.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289:2560–2571.
14.
Hosmer D, Lemeshow S: Applied Logistic Regression Analysis, ed 2. New York, John Wiley & Sons, 2000.
15.
Landsberg L, Young JB: Fasting, feeding and regulation of the sympathetic nervous system. N Engl J Med 1978;298:1295–1301.
16.
Jung RT, Shetty PS, Barrand M, Callingham BA, James WP: Role of catecholamines in hypotensive response to dieting. Br Med J 1979;1:12–13.
17.
Messerli FH, Christie B, DeCarvalho JG, Aristimuno GG, Suarez DH, Dreslinski GR, et al: Obesity and essential hypertension. Hemodynamics, intravascular volume, sodium excretion, and plasma renin activity. Arch Intern Med 1981;141:81–85.
18.
Dannenberg AL, Kannel WB: Remission of hypertension. The ‘natural’ history of blood pressure treatment in the Framingham Study. JAMA 1987;257:1477–1483.
19.
Schmieder RE, Rockstroh JK, Messerli FH: Antihypertensive therapy. To stop or not to stop? JAMA 1991;265:1566.
20.
Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G, et al: Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2011;365:1959–1968.
21.
Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. The Trials of Hypertension Prevention Collaborative Research Group. Arch Intern Med 1997;157:657–667.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.