Abstract
Weight reduction is generally recommended as the first line of treatment for the increasing problem of obesity-associated hypertension. At first glance, this recommendation seems compelling, but evidence suggests that weight loss for obesity-associated hypertension is neither simple nor consistently effective as antihypertensive therapy. First, dietary and behavioral therapy is accompanied by an extremely high rate of weight regain after loss. Mounting evidence shows that this recidivism reflects neurobiologic and not simply psychologic adaptations to dietary restriction. Second, chronic blood pressure-lowering effects of weight loss produced by diet, weight-reducing drugs, or bariatric surgery may not be as pronounced as commonly thought. Third, there is evidence that dietary restriction, independent of weight loss, reduces sympathetic nervous system activity and might thereby contribute to reducing blood pressure. This phenomenon deserves more consideration in designing and interpreting studies of blood pressure changes during diet-induced weight loss. This article reviews these issues and highlights the nuances and challenges in the effectiveness of weight loss for treatment of obesity-induced hypertension.
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References and Recommended Reading
Jordan J, Engeli S, Redon J, et al.: European Society of Hypertension Working Group on Obesity: background, aims and perspectives. J Hypertens 2007, 25:897–900.
Alexander JK, Amad KH, Cold VW: Observation on some clinical features of extreme obesity with particular reference to cardiorespiratory effects. Am J Med 1962, 32:512–524.
Mark AL, Correia M, Morgan DA, et al.: Obesity-induced hypertension: new concepts from the emerging biology of obesity. Hypertension 1999, 33:537–541.
Correia MLG, Haynes WG, Rahmouni K, et al.: The concept of selective leptin resistance: evidence from agouti yellow obese mice. Diabetes 2002, 51:439–442.
Rahmouni R, Morgan DA, Morgan GM, et al.: Role of selective leptin resistance in diet-induced obesity hypertension. Diabetes 2005, 54:2012–2018.
Mark AL, Correia MLG, Rahmouni K, Haynes WG: Selective leptin resistance: a new concept in leptin physiology with cardiovascular implications. J Hypertension 2002, 20:1245–1250.
Klein S, Fontana L, Young L, et al.: Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004, 350:2549–2557.
Kanai H, Tokunaga K, Fujioka S, et al.: Decrease in intra-abdominal visceral fat may reduce blood pressure in obese hypertensive women. Hypertension 1996, 27:125–129.
Rahmouni K, Mark AL, Haynes WG, Sigmund CD: Adipose depot-specific modulation of angiotensinogen gene expression in diet-induced obesity. Am J Physiol 2004, 286:E891–E895.
Ramsay LE, Ramsay MH, Hettiarachchi, et al.: Weight reduction in a blood pressure clinic. Brit Med J 1978, 2:244–245.
Tuck ML, Sowers J, Dornfeld L, et al.: The effect of weight reduction on blood pressure, plasma renin activity, and plasma aldosterone levels in obese patients. N Engl J Med 1981, 304:930–933.
Fagerberg B, Andersson OK, Isaksson, Bjorntorp P: Blood pressure control during weight reduction in obese hypertensive men: separate effects of sodium and energy restriction. Brit Med J 1984, 288:11–14.
Dornfeld LP, Maxwell MH, Waks AU, et al.: Obesity and hypertension: long-term effects of weight reduction on blood pressure. Int J Obes 1985, 9:381–389.
MacMahon S, Cutler J, Brittain E, Higgins M: Obesity and hypertension: epidemiological and clinical issues. Eur Heart J 1987, 8(Suppl B): 57–70.
Rocchini AP, Katch V, Schork A, Kelch RP: Insulin and blood pressure during weight loss in obese adolescents. Hypertension 1987, 10:267–273.
Schotte DE, Stunkard AJ: The effects of weight reduction on blood pressure in 301 obese patients. Arch Intern Med 1990, 150:1701–1704.
Hypertension Prevention Trial Research Group: The Hypertension Prevention Trial; three-years effects of dietary changes on blood pressure. Arch Intern Med 1990, 150:153–162.
The effects of nonpharmacologic interventions on blood pressure of persons with high normal levels. Results of the Trials of Hypertension Prevention. Phase 1. JAMA 1992, 267:1213–1220.
The Trials of Hypertension Prevention Collaborative Research Group: 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. Arch Intern Med 1997, 157:657–667.
Dengel DR, Galecki AT, Hagberg JM, Pratley RE: The independent and combined effects of weight loss and aerobic exercise on blood pressure and oral glucose tolerance in older men. Am J Hypertens 1998, 11:1405–1412.
Whelton PK, Appel LJ, Espeland MA, et al.: Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). JAMA 1998, 279:839–846.
Mertens IL, Van Gaal LF: Overweight, obesity and blood pressure: the effects of modest weight reduction. Obes Res 2000, 8:270–278.
Neter JE, Stam BE, Kok FJ, et al.: Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003, 42:878–884.
Aucott L, Poobalan A, Smith WCS, et al.: Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension 2005, 45:1035–1041.
Winnicki M, Bonso E, Dorigatti F, et al.: Effect of body weight loss on blood pressure after 6 years of follow-up in stage 1 hypertension. Am J Hypertens 2006, 19:1103–1109.
Sonne-Holm S, Sorensen TIA, Jensen G, Schnohr P: Independent effects of weight change and attained body weight on prevalence of arterial hypertension in obese and non-obese men. Brit Med J 1989, 299:767–770.
Landsberg L: Feast or famine: the sympathetic nervous system response to nutrient intake. Cell Mol Neurobiol 2006, 26:497–508.
Landsberg L: A teleological view of obesity, diabetes and hypertension. Clin Exp Pharmacol Physiol 2006, 33:863–867.
Mark AL: Dietary therapy for obesity is the future and pharmacotherapy is the future: a point of view. Clin Exp Pharmacol Physiol 2006, 33:857–862.
Levin BE: The drive to regain is mainly in the brain. Am J Physiol 2004, 287:R1297–R1300.
Hill JO: Understanding and addressing the epidemic of obesity: an energy balance perspective. Endocr Rev 2006, 27:750–761.
Kolata G: Rethinking Thin: The New Science of Weight Loss—and the Myths and Realities of Dieting. New York: Farrar, Straus and Giroux; 2007.
Buchwald H, Avidor Y, Braunwald E, et al.: Bariatric surgery: a systematic review and meta-analysis. JAMA 2004, 292:1724–1737.
Sjostrom L, Lindroos A-K, Peltonen M, et al.: Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004, 351:2683–2693.
Sjostrom CD, Peltonen M, Wedel H, Sjostrom L: Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2006, 36:20–25.
Sjostrom CD, Peltonen M, Sjostrom L: Blood pressure and pulse pressure during long-term weight loss in the obese: the Swedish Obese Subjects (SOS) intervention study. Obes Res 2001, 9:188–195.
Sharma AM, Golay A: Effect of orlistat-induced weight loss on blood pressure and heart rate in obese patients with hypertension. J Hypertens 2002, 20:1731–1735.
Hazenberg BP: Randomized, double-blind, placebo-controlled, multicenter study of sibutramine in obese hypertensive patients. Cardiology 2000, 94:152–158.
Birkenfeld AL, Schroeder C, Pischon T, et al.: Paradoxical effect of sibutramine on autonomic cardiovascular function in obese hypertensive patients—sibutramine and blood pressure. Clin Auton Res 2005, 15:200–206.
Jordan J, Scholze J, Matiba B, et al.: Influence of sibutramine on blood pressure: evidence from placebo-controlled trials. Int J Obes 2005, 29:509–516.
Scholze J, Grimm E, Herrmann D, et al.: Optimal treatment of obesity-related hypertension. The Hypertension-Obesity-Sibutramine (HOS) study. Circulation 2007, 115:1991–1998.
Batkai S, Pacher P, Osei-Hyiamaan D, et al.: Endocannabinoids acting at cannabinoid-1 receptors regulate cardiovascular function in hypertension. Circulation 2004, 110:1996–2002.
Van Gaal LF, Rissanen AM, Scheen AJ, et al.: Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in over weight patients: 1-year experience from the RIO-Europe study. Lancet 2005, 365:1389–1397.
Pi-Sunyer FX, Aronne LJ, Heshmati HM, et al.: Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients. JAMA 2006, 295:761–775.
Despre J-P, Golay A, Sjostrom L: Effects of rimonanbant on metabolic risk factors in overweight patients with dyslipidemia. N Engl J Med 2005, 353:2121–2134.
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Mark, A.L. Weight reduction for treatment of obesity-associated hypertension: Nuances and challenges. Current Science Inc 9, 368–372 (2007). https://doi.org/10.1007/s11906-007-0068-5
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DOI: https://doi.org/10.1007/s11906-007-0068-5