Study: Medications, Surgery May Help Obesity-Related High Blood Pressure in Lieu of Diet, Exercise

The national guidelines recommend a heart-healthy diet to help manage weight and control blood pressure, while also emphasizing dietary patterns rather than individual foods and nutrients.

A new American Heart Association (AHA) guidance states that weight-loss medications and surgical procedures are promising for reducing the long-term effects of high blood pressure in people who are overweight or have obesity, according to an AHA press release.

“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, MD, MS, FAHA, in the press release. “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.”

Although previous statements from the AHA have addressed the impact of diet, physical activity, and weight control related to blood pressure, the latest statement is focused on obesity-related high blood pressure and included experts in the fields of obesity and high blood pressure.

The national guidelines recommend a heart-healthy diet to help manage weight and control blood pressure, while also emphasizing dietary patterns rather than individual foods and nutrients.

“There’s no doubt that eating healthy foods has beneficial effects on both weight and blood pressure,” Hall said in the press release. “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.”

Additionally, intermittent fasting produced weight reduction and modest reductions in blood pressure in a few studies involving people with metabolic syndrome, in a group of 5 conditions that can lead to heart disease, including high blood sugar, low levels of high-density lipoprotein cholesterol, high triglyceride levels, large waist circumference, and high blood pressure. An analysis of multiple studies found that intermittent fasting had a weak impact on blood pressure and was no more effective than other diets in reducing weight.

Lowering body weight and reducing blood pressure can be done by increasing physical activity or improving cardiovascular fitness. The AHA specifically suggests exercise is critical to reduce weight and lower blood pressure.

The statement also notes that prescription medications are not successful in achieving weight reduction and blood pressure control among people with obesity, who are overweight, or have a weight-related health issue.

“Currently, only a fraction of eligible individuals are prescribed medicine or referred for metabolic surgery,” Hall said in the press release. “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.”

GLP-1 receptor agonists, a newer class of medications, have been shown to help with sustained weight loss and significantly reducing blood pressure. Liraglutide and semaglutide are examples of agonists that are self-administered in a daily or weekly injection and help people reduce appetite and feel fuller.

Surgery can also be an option in weight loss for people with severe obesity, also known as bariatric surgery or gastric bypass surgery, which is included in the statement.

“Metabolic surgery techniques are continuing to evolve, and they are getting less invasive and less risky,” Hall said in the press release. “For select individuals, medications or metabolic surgery or both may be considered in addition to healthy diet and increased physical activity.”

Other questions and gaps of the data on the use of medications and surgery to prevent and treat obesity-related hypertension were included in the statement, such as whether the 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 efficacy 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,” Hall said in the press release.

REFERENCE

Meds, surgery may help obesity-related high blood pressure if diet, exercise fall short. American Heart Association. September 21, 2021. Accessed September 21, 2021. https://newsroom.heart.org/news/meds-surgery-may-help-obesity-related-high-blood-pressure-if-diet-exercise-fall-short