Medication and surgery can help obesity-linked high blood pressure if diet and exercise aren’t enough


Weight loss drugs and surgeries show promise in reducing the long-term effects of high blood pressure (also called hypertension) in overweight or obese people, according to a new scientific statement from the American Heart Association released today in the Association’s journal. Hypertension. A scientific statement is an expert analysis of current research and may inform future guidelines.

“Weight loss achieved through dietary changes and increased physical activity are cornerstones in the treatment of high blood pressure associated with overweight. However, these lifestyle behaviors are often not sustained over the long term. Subsequently, the reductions in blood pressure are not sustained. over time, ”said statement writing group chairman Michael E. Hall, MD, MS, FAHA, deputy director of the cardiovascular disease division at the University of Mississippi Medical Center in Jackson, Mississippi. “The new scientific statement suggests that medical and surgical strategies can help improve long-term weight and blood pressure, in addition to heart-healthy eating and physical activity.”

Previous scientific statements from the American Heart Association have addressed the impact of diet, physical activity, and weight control on blood pressure. The new statement focuses on high blood pressure linked to obesity. Being overweight or obese is heavier weight than what is considered healthy for an individual’s height. Specifically, a body mass index (BMI) of 30 or more is considered obesity, and a BMI of 25 to 29 is considered overweight. The scientific statement writing group included experts in the fields of obesity and high blood pressure, and they reviewed existing research to provide the latest guidance on weight loss strategies to reduce high blood pressure. .

The impact of diet and physical activity

National guidelines recommend heart-healthy eating to help manage weight and control blood pressure. These guidelines focus on eating habits rather than individual foods and nutrients. The best established healthy eating habits are the Mediterranean Diet and Dietary Approaches to Stop Hypertension (DASH). The diets are similar with an emphasis on consuming more fruits, vegetables, legumes, nuts and seeds with moderate amounts of fish, seafood, poultry and dairy products, and low amounts of red and processed meats and sweets.

“There is no question that eating healthy foods has beneficial effects on weight and blood pressure,” Hall said. “Many weight loss diets are often effective in the short term; however, eating healthy foods consistently over the long term and maintaining weight loss is a challenge. “

Intermittent fasting, an approach that changes when to eat and fast during the day or every week, has produced some weight reduction and modest reductions in blood pressure in a few studies involving people with metabolic syndrome – a group of five conditions that can lead to heart disease, including high blood sugar, low HDL cholesterol, high triglyceride levels, large waistline and high blood pressure. Metabolic syndrome is diagnosed when a person has at least three of these conditions. However, analyzes of several studies found that intermittent fasting had little impact on blood pressure and was no more effective than other diets in reducing weight.

Increasing physical activity along with improving cardiovascular fitness and reducing sedentary time can help reduce body weight and blood pressure. The statement suggests that exercise is essential for reducing weight and lowering blood pressure, as confirmed by the Association’s June 2021 statement on the first-line treatment of high blood pressure and cholesterol.

Medicines for weight loss

While lifestyle changes have not been successful in reducing weight and controlling blood pressure, the statement suggests prescription drugs may be considered for people who are obese or overweight and have a weight-related health problem. , such as high blood pressure.

“Currently, only a fraction of eligible people are prescribed drugs or are referred for metabolic surgery,” Hall said. “Often, we don’t consider drugs or metabolic surgery until there has been target organ damage, such as a heart injury or stroke. However, we may be able to prevent these complications. ‘Combined with lifestyle changes, anti-obesity medications, and surgeries can be effective long-term solutions for weight loss and blood pressure control in some overweight or obese people. “

A new class of drugs called GLP-1 receptor agonists have been shown to help sustain weight loss and dramatically lower blood pressure, the release said. GLP-1 agonists, such as liraglutide and semaglutide, are synthetic hormones, self-administered as a daily or weekly injection, that reduce appetite and help people feel full. Both drugs were originally approved to treat type 2 diabetes because they lower blood sugar by stimulating the release of insulin. The United States Food and Drug Administration recently approved the two drugs for weight management and weight loss in people classified as overweight or obese.

Surgery to lose weight

Metabolic surgery (also called bariatric surgery or gastric bypass surgery) can promote weight loss in people with severe obesity, defined as people with a BMI of 40 or more, or if they have a BMI of 35 or more. more with a BMI linked to obesity. health condition, including hypertension. The statement includes a review of research on metabolic surgery. High blood pressure was resolved in 63% of people who had metabolic surgery, and several studies showed a decrease in the use of hypotensive drugs after surgery.

“Metabolic surgery techniques continue to evolve, and they become less invasive and less risky,” Hall said. “For some people, drugs or metabolic surgery or both may be considered in addition to a healthy diet and increased physical activity.”

The statement also highlights issues and gaps in research data on the use of drugs and surgery to prevent and treat obesity-related hypertension. These include whether these strategies will have the desired result of preventing organ damage, how effective they are for people who already have kidney disease or heart failure, and how to compare the effectiveness. medication, surgery, or a combination of the two to determine the best approach to long-term blood pressure reduction.

“There are still many unanswered questions and many research opportunities that can help people live healthier, longer lives,” Hall said.

This scientific statement was prepared by the Volunteer Editorial Group on behalf of the Hypertension Council of the American Heart Association; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Cardiometabolic Health and Lifestyle Council; and the Stroke Council.

Co-authors are Vice President Jordana B. Cohen, MD, MSCE; Jamy D. Ard, MD; Brent M. Egan, MD, FAHA; John E. Hall, Ph.D., FAHA; Carl J. Lavie, MD; Jun Ma, MD, Ph.D., FAHA; Chiadi E. Ndumele, MD, MHS; Philip R. Schauer, MD; and Daichi Shimbo, MD Author disclosures are listed in the manuscript.


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