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News From the AMA:
Dieting and Medication May Reduce Blood Pressure in
Patients With Hypertension
March 31, 2008 — Adults with hypertension may be able to lower their weight and their blood pressure by following a weight-loss diet or using the medication orlistat, according to a meta-analysis of previously published studies reported in the March 24 issue of Archives of Internal Medicine, a journal of the American Medical Association.
High blood pressure (hypertension) is a major risk factor for cardiovascular disease and is responsible for approximately seven million deaths worldwide each year, according to background information in the article. Lowering blood pressure levels in those with hypertension has been shown to reduce cardiovascular risk, with corresponding decreases in illness and death. "Weight reduction is recommended in major guidelines as an initial intervention in the treatment of hypertensive patients," the authors write. "Among the possible means of reducing body weight are lifestyle modifications and pharmacologic and invasive interventions."
Karl Horvath, M.D., of the Medical University of Graz, Australia, and colleagues performed a meta-analysis of 48 articles that were published before March 2007 and analyzed weight-loss interventions for patients with hypertension. Of those studies, 38 assessed diet and 10 focused on medications for weight loss, including five evaluating orlistat and five assessing sibutramine. No relevant articles were located regarding the weight loss drug rimonabant or evaluating surgical weight reduction.
"Patients assigned to weight loss diets, orlistat or sibutramine reduced their body weight more effectively than did patients in the usual care/placebo groups," the authors write. "Reduction of blood pressure was higher in patients treated with weight loss diets or orlistat." Sibutramine treatment, however, did not lower overall blood pressure and appeared to increase systolic (top number) blood pressure.
"A reduction in body weight of approximately four kilograms [8.8 pounds] was necessary to achieve a reduction of approximately six milligrams of mercury in systolic blood pressure with dietary treatment and of approximately 2.5 milligrams of mercury with orlistat," the authors write. "None of the studies provided data to answer the question whether risk of mortality [death] or other patient-relevant end points can be lowered by weight reduction."