Meds, surgery may help obesity-related high blood pressure if diet,
exercise fall short

Date:
September 20, 2021
Source:
American Heart Association
Summary:
Being overweight or having obesity, weight that is higher than what
is considered healthy for an individual's height, is a major risk
factor for high blood pressure. A healthy diet, more physical
activity and less sedentary time are recommended to reduce
blood pressure for people who are overweight or have obesity;
however, evidence of long-term weight loss and sustained blood
pressure reductions from these lifestyle changes is limited. New
weight-loss medications and bariatric surgery have shown benefits
in both long-term weight loss and improved blood pressure, which
can reduce the long-term, negative impact of high blood pressure
on organ damage.



FULL STORY ========================================================================== Weight-loss medications and surgical procedures show promise for
reducing the long-term effects of high blood pressure (also called hypertension) in people who are overweight or have obesity, according
to a new American Heart Association scientific statement published 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 the cornerstones of treatment for high blood pressure
that's related to being overweight. However, these lifestyle behaviors
are often not sustained over the long term. Subsequently, reductions in
blood pressure aren't maintained over time," said Chair of the statement writing group Michael E.

Hall, M.D., M.S., FAHA, associate division director for cardiovascular
diseases at the University of Mississippi Medical Center in Jackson, Mississippi. "The new scientific statement suggests medical and surgical strategies may help with long-term weight and blood pressure improvement,
in addition to a heart-healthy diet and physical activity." Previous scientific statements from the American Heart Association have addressed
the impact of diet, physical activity and weight control related to
blood pressure. The new statement is focused on obesity-related high
blood pressure. Overweight or obesity is weight that is higher than
what is considered healthy for an individual's height. Specifically,
a body mass index (BMI) of 30 or greater is considered obesity, and a
BMI of 25 to 29 is classified as overweight. The writing group for the scientific statement 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 a heart-healthy diet to help manage weight and control blood pressure. These guidelines emphasize dietary pattern rather than individual foods and nutrients. The most well-established healthy eating patterns are the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH). The diets are similar in emphasizing eating more fruits, vegetables, legumes,
nuts and seeds with moderate amounts of fish, seafood, poultry and dairy,
and low quantities of red and processed meats, and sweets.

"There's no doubt that eating healthy foods has beneficial effects on
both weight and blood pressure," said Hall. "Numerous weight-loss diets
are often successful in the short term; however, eating healthy foods consistently and long term, and maintaining weight loss are challenging." Intermittent fasting, an approach that alters the timing of eating and
fasting during the day or each week, 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 levels of HDL cholesterol, high triglyceride levels, large waist circumference and
high blood pressure. Metabolic syndrome is diagnosed when someone has
three or more of these conditions. However, analyses of several studies
found that intermittent fasting had a weak impact on blood pressure and
was no more effective than other diets in reducing weight.



========================================================================== Increasing physical activity as well as improving cardiovascular fitness
and reducing the amount of sedentary time can help lower body weight and
reduce blood pressure. The statement suggests exercise is critical to
reduce weight and lower blood pressure, as supported by the Association's
June 2021 statement on first-line treatment for elevated blood pressure
and cholesterol.

Medications for weight loss If lifestyle modifications have not been
successful in achieving weight reduction and blood pressure control,
the statement suggests prescription medications may be considered for
people who have obesity or who are overweight and have a weight-related
health issue such as high blood pressure.

"Currently, only a fraction of eligible individuals are prescribed
medicine or referred for metabolic surgery," said Hall. "We often don't consider medications or metabolic surgery until after there has been
target organ damage, such as heart injury or having a stroke. However, we
may be able to prevent these complications. When combined with lifestyle changes, anti-obesity medicines and surgical procedures can be effective long-term solutions for weight loss and blood pressure control in select individuals who are overweight or have obesity." A newer class of
medications called GLP-1 receptor agonists have been shown to help with sustained weight loss and significantly reducing blood pressure, according
to the statement. GLP-1 agonists, such as liraglutide and semaglutide,
are synthetic hormones, self-administered in a daily or weekly injection,
that reduce appetite and help people to feel full. Both medications were initially approved to treat type 2 diabetes because they lower blood
sugar by stimulating the release of insulin. The U.S. Food and Drug Administration recently approved both medications for weight management
and weight loss in individuals classified as overweight or obesity.



========================================================================== Surgery for weight loss Metabolic surgery (also called bariatric
surgery or gastric bypass surgery) can aid weight loss in people with
severe obesity, defined as people who have a BMI of 40 or higher, or if
they have a BMI of 35 or higher along with an obesity- related health
condition including hypertension. The statement includes a research
review on metabolic surgery. High blood pressure was resolved in 63%
of people who had metabolic surgery, and several studies showed less
use of blood pressure-lowering medicines after surgery.

"Metabolic surgery techniques are continuing to evolve, and they are
getting less invasive and less risky," said Hall. "For select individuals, medications or metabolic surgery or both may be considered in addition
to healthy diet and increased physical activity." The statement also highlights questions and gaps in research data on the use of medications
and surgery to prevent and treat obesity-related hypertension.

These issues include whether these strategies will have the intended
outcome of preventing organ damage, how effective they are for individuals
who already have kidney disease or heart failure, and comparing the effectiveness of medications, surgery or a combination of both to
determine the best approach for long-term blood pressure reduction.

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

This scientific statement was prepared by the volunteer writing group
on behalf of the American Heart Association's Council on Hypertension;
the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the
Council on Lifestyle and Cardiometabolic Health; and the Stroke Council.

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

========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Michael E. Hall, Jordana B. Cohen, Jamy D. Ard, Brent M. Egan,
John E.

Hall, Carl J. Lavie, Jun Ma, Chiadi E. Ndumele, Philip R. Schauer,
Daichi Shimbo. Weight-Loss Strategies for Prevention and Treatment
of Hypertension: A Scientific Statement From the American Heart
Association.

Hypertension, 2021; DOI: 10.1161/HYP.0000000000000202 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/09/210920082139.htm

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