MODEST WEIGHT LOSS AND BLOOD PRESSURE CONTROL;
IT REALLY DOES WORK

(January 2002)

The January 2, 2001 issue of the Annals of Internal Medicine includes a very important article on the effects of weight loss on those with diastolic blood pressures in the upper part of the normal range (being in the upper part of the normal range is a risk factor for heart attacks and strokes); a high blood pressure, that is above the normal range, is an even greater risk factor.

The investigators studied 595 men and women who were 10 to 65 percent above ideal weight (a little overweight to a lot overweight), average age 43 years, with an average systolic pressure of 127 millimeters of mercury (a little bit above what is desirable) and an average diastolic pressure of 86 millimeters of mercury (in the upper part of the normal range). The participants received a lot of counseling to achieve weight loss. They were compared with 596 controls who were not given any weight reduction counseling.

The results, in part, show the problems involved in weight reduction and keeping the weight off. At six months, on average, the diet group lost almost 10 pounds. At eighteen months, the group was attending fewer counseling sessions and the weight loss was an average 4.5 pounds. By three years, they were, on average, back to their original weights, but still differed from the control group who had, on average, gained 4 pounds. At six months, when the weight loss was greatest, the diastolic blood pressure fell, on average, 2.7 millimeters of mercury (that does not sound like a lot, but it really is quite significant). Those who lost the most weight (almost 20 pounds) dropped their diastolic blood pressure by 7 millimeters of mercury and their systolic pressures by 5 millimeters of mercury (in both cases, very significant drops). Those who managed to keep the weight off during the three-year period maintained their lower blood pressures.

The authors concluded "significant long-term reductions in blood pressure and reduced risk for hypertension can be achieved with even modest weight loss".

Commentary: This is a very good study. It agrees with many other studies. Moderate weight loss can be very helpful not only for those with elevated blood pressures, but also for those with blood pressures in the upper part of the normal range who are at some increased risk of heart attack and stroke, and also at increased risk of becoming hypertensive with resulting further increase in risk of heart attack and stroke.

But there is a warning in this report. Even this motivated group given extensive counseling had trouble with weight management. As a group, they showed decreasing interest in the counseling and weight loss over the three years, and did not maintain either the weight loss or blood pressure reduction. Only 13 percent lost 10 pounds or more, and then kept it off for the three-year study period.

If your blood pressure is in the upper part of the normal range (over 85 millimeters of mercury diastolic, or over 130 millimeters of mercury systolic), or if you have high blood pressure and if you are in the upper part of your normal weight range or you are overweight (click for weight tables), you should lose weight. Weight loss requires caloric restriction and, for those with elevated blood pressure, probably also salt restriction (although weight loss without changes in salt intake will succeed for many people). The big issue is how to keep it off. That requires continuing attention to what you eat and, for most people, regular exercise. For weight maintenance once you have lost weight, follow our nutrition guidelines (click here) and use common sense.

If you have hypertension, you should also be under the care of a physician.

Stevens, V.J., et al. Long-term weight loss and changes in blood pressure. Annals of Internal Medicine. Vol 134. (January 2) Pgs 1-11. 2001.