Non‐interventional weight changes affect systolic blood pressure in normotensive individuals

The association between obesity and hypertension is well established. Weight loss has been shown to reduce blood pressure (BP) among hypertensive patients. Nevertheless, the effect of weight changes on BP in normotensive individuals is less clear. The author explored the association between non‐interventional weight alterations and BP changes in a large cohort of normotensive adults. This is a retrospective analysis of normotensive individuals, between 2010 and 2018. All weight changes were non‐interventional. Body mass index (BMI) and BP were measured annually. Patients were divided according to the change in BMI between visits: reduction of more than 5% ("large reduction"), between 2.5% and 5% ("moderate reduction"), reduction of <2.5% or elevation of <2.5% ("unchanged"), elevation between 2.5% and 5% ("moderate increase"), and elevation of more than 5% ("large increase"). The primary outcome was the change in systolic BP (SBP) between the visits. The final analysis included 8723 individuals. 20% of the patients reduced their BMI by at least 2.5% and 24.5% increased their BMI by more than 2.5%. "High reduction" inferred an absolute decrease of 3.6 mmHg in SBP, while "large increase" resulted in an absolute increase of 1.9 mmHg in SBP. The proportion of individuals with at least 10 mmHg decrease in SBP progressively declined according to the relative decrease in BMI, and the proportion of patients with at least 10 mmHg increase in SBP progressively increased. This effect was more pronounced in individuals with higher baseline SBP. Among normotensive adults, modest non‐interventional weight changes may have significant effects on SBP.

[1]  C. Schiavon Correction to: Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). , 2019, Circulation.

[2]  Deepak L. Bhatt,et al.  Metabolic Surgery for Hypertension in Patients With Obesity , 2019, Circulation research.

[3]  R. Brook,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Journal of the American Society of Hypertension : JASH.

[4]  Yong U. Choi,et al.  Time Course of Blood Pressure Decrease After Bariatric Surgery in Normotensive and Hypertensive Patients , 2018, Obesity Surgery.

[5]  D. Ryan,et al.  Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over , 2017, Current Obesity Reports.

[6]  Isabelle Romieu,et al.  Obesity and cancer: An update of the global impact. , 2016, Cancer epidemiology.

[7]  D. Williamson,et al.  Is 5% weight loss a satisfactory criterion to define clinically significant weight loss? , 2015, Obesity.

[8]  J. Filosa,et al.  Adipocyte-Derived Hormone Leptin Is a Direct Regulator of Aldosterone Secretion, Which Promotes Endothelial Dysfunction and Cardiac Fibrosis , 2015, Circulation.

[9]  V. Kristiansen,et al.  Roux-en-Y gastric bypass alleviates hypertension and is associated with an increase in mid-regional pro-atrial natriuretic peptide in morbid obese patients , 2015, Journal of hypertension.

[10]  M. Budoff,et al.  The association of nonalcoholic fatty liver disease, obesity, and metabolic syndrome, with systemic inflammation and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA). , 2015, Atherosclerosis.

[11]  A. Cox,et al.  Obesity, inflammation, and the gut microbiota. , 2015, The lancet. Diabetes & endocrinology.

[12]  G. Chodick,et al.  Prevalence and Factors Associated With Resistant Hypertension in a Large Health Maintenance Organization in Israel , 2014, Hypertension.

[13]  Alan D. Lopez,et al.  Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013 , 2014, The Lancet.

[14]  Graham A Colditz,et al.  The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. , 2014, JAMA surgery.

[15]  Janusz Wnek,et al.  2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults , 2013, Circulation.

[16]  R. Iliescu,et al.  The Sympathetic Nervous System in Obesity Hypertension , 2013, Current Hypertension Reports.

[17]  Audrey Y. Chu,et al.  Body Mass Index and Risk of Incident Hypertension Over the Life Course: The Johns Hopkins Precursors Study , 2012, Circulation.

[18]  T. Wadden,et al.  Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes , 2011, Diabetes Care.

[19]  J. Mariani,et al.  Exercise augments weight loss induced improvement in renal function in obese metabolic syndrome individuals , 2011, Journal of hypertension.

[20]  Wei Zhang,et al.  The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis , 2009, BMC public health.

[21]  G. Bray,et al.  Weight loss and blood pressure control (Pro). , 2008, Hypertension.

[22]  I. Olkin,et al.  Using pedometers to increase physical activity and improve health: a systematic review. , 2007, JAMA.

[23]  Melonie P. Heron,et al.  Deaths: leading causes for 2004. , 2007, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[24]  P. Palatini,et al.  Effect of body weight loss on blood pressure after 6 years of follow-up in stage 1 hypertension. , 2006, American journal of hypertension.

[25]  Carlos Iribarren,et al.  Body Mass Index and Risk for End-Stage Renal Disease , 2006, Annals of Internal Medicine.

[26]  K. Flegal,et al.  Prevalence of overweight and obesity in the United States, 1999-2004. , 2006, JAMA.

[27]  A. Divani,et al.  Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000. , 2005, Medical science monitor : international medical journal of experimental and clinical research.

[28]  Arya M. Sharma,et al.  Weight Loss and the Renin-Angiotensin-Aldosterone System , 2005, Hypertension.

[29]  Diederick E. Grobbee,et al.  Influence of Weight Reduction on Blood Pressure: A Meta-Analysis of Randomized Controlled Trials , 2003, Hypertension.

[30]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[31]  M. Jadoul,et al.  Obstructive sleep apnoea , 2002, The Lancet.

[32]  Alan D. Lopez,et al.  Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest , 2002 .

[33]  N. Milas,et al.  Long-Term Weight Loss and Changes in Blood Pressure: Results of the Trials of Hypertension Prevention, Phase II , 2001, Annals of Internal Medicine.

[34]  G. Bray,et al.  A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. , 1997, The New England journal of medicine.

[35]  M. Evans,et al.  Body weight and mortality among women. , 1997, Canadian family physician Medecin de famille canadien.

[36]  M. Blaufox,et al.  Reduction in long-term antihypertensive medication requirements. Effects of weight reduction by dietary intervention in overweight persons with mild hypertension. , 1993, Archives of internal medicine.

[37]  J. Cutler Randomized clinical trials of weight reduction in nonhypertensive persons. , 1991, Annals of epidemiology.

[38]  E. Frohlich,et al.  Renal Haemodynamic Studies in Obesity Hypertension , 1987, Journal of hypertension.

[39]  HELEN B. HUBERT,et al.  Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26‐year Follow‐up of Participants in the Framingham Heart Study , 1983, Circulation.

[40]  E. Reisin,et al.  Bariatric Surgery and Hypertension , 2017, American journal of hypertension.

[41]  M. Szklo,et al.  The Multi-Ethnic Study of Atherosclerosis (MESA) , 2012 .

[42]  A. Berghold,et al.  Long-term effects of weight-reducing diets in hypertensive patients. , 2011, The Cochrane database of systematic reviews.

[43]  J. Danesh,et al.  Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. , 2011, Lancet.

[44]  Ian Janssen,et al.  Vascular Risks and Management of Obesity in Children and Adolescents , 2006, Vascular health and risk management.

[45]  E. Roccella,et al.  Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium. , 2004, American journal of public health.

[46]  J. Staessen,et al.  The relationship between body weight and blood pressure. , 1988, Journal of human hypertension.

[47]  A. Eshkol,et al.  Diet and weight loss: their effect on norepinephrine renin and aldosterone levels. , 1985, International journal of obesity.

[48]  J. Stamler,et al.  Weight and blood pressure. Findings in hypertension screening of 1 million Americans. , 1978, JAMA.