In those who are overweight or obese, weight-loss drugs and surgical treatments show promise in lowering the long-term effects of high blood pressure (also known as hypertension). A new American Heart Association scientific statement published today in the Association’s journal Hypertension supports this conclusion.
A scientific statement is a professional review of current research that may help to shape future guidelines. “The pillars of treatment for high blood pressure linked to obesity are weight loss achieved via dietary adjustments and increased physical activity. However, these lifestyle choices are rarely maintained in the long run. As a result, blood pressure decreases aren’t sustained over time “Michael E. Hall, M.D., M.S., FAHA, associate division director for cardiovascular diseases at the University of Mississippi Medical Center in Jackson, Mississippi, chaired the statement writing group.
“The new scientific statement shows that, in addition to a heart-healthy diet and physical activity, medicinal and surgical methods may aid with long-term weight and blood pressure improvement,” he continued.
The American Heart Association has previously issued scientific declarations on the effects of food, physical activity, and weight control on blood pressure. Obesity-related high blood pressure is the emphasis of the new statement. Overweight or obesity refers to a person’s weight being higher than what is deemed healthy for their height. Obesity is defined as a body mass index (BMI) of 30 or higher, whereas overweight is defined as a BMI of 25 to 29. Experts in the disciplines of obesity and high blood pressure made up the writing group for the scientific statement, and they analyzed existing data to provide the most up-to-date advice on weight-loss measures to lower blood pressure.
To assist manage weight and blood pressure, the influence of food and physical activity guidelines propose a heart-healthy diet. Individual foods and nutrients are less important in these guidelines than dietary patterns. The Mediterranean diet and Dietary Approaches to Stop Hypertension are two of the most well-known healthy eating patterns (DASH). The diets are similar in that they emphasize eating more fruits, vegetables, legumes, nuts, and seeds, as well as moderate amounts of fish, seafood, chicken, and dairy, as well as limited amounts of red and processed meats, as well as sweets.
“There’s no doubt that eating healthy foods helps with weight loss and blood pressure,” Hall added.
“While many weight-reduction regimens are effective in the short term, eating healthy meals regularly and long term, as well as maintaining weight loss, is difficult.”
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, and a large waist circumference – intermittent fasting, an approach that changes the timing of eating and fasting during the day or each week, produced some weight loss and modest reductions in blood pressure. When three or more of these symptoms are present, metabolic syndrome is diagnosed. Intermittent fasting, on the other hand, had a minor effect on blood pressure and was no more effective than other diets in terms of weight loss, according to many studies.
Lowering body weight and blood pressure can be achieved through increasing physical activity, enhancing cardiovascular fitness, and reducing inactive time. The statement recommends that exercise is important for losing weight and lowering blood pressure, which is supported by the American Heart Association’s statement on first-line treatment for high blood pressure and cholesterol from June 2021. Weight-loss medications If lifestyle changes fail to achieve weight loss and blood pressure control, prescription drugs may be explored for adults with obesity or who are overweight and have a weight-related health condition such as high blood pressure, according to the statement.
“At the moment, only a small percentage of those who are qualified get provided medication or referred for metabolic surgery,” Hall added. “We don’t usually think about drugs or metabolic surgery until there has been damage to the target organ, such as a heart attack or a stroke. We may, however, be able to avoid these difficulties. Anti-obesity drugs and surgical procedures, when paired with lifestyle changes, can be effective long-term options for weight loss and blood pressure control in overweight or obese people.”
According to the statement, a novel class of drugs known as GLP-1 receptor agonists has been demonstrated to aid in long-term weight loss and dramatically lower blood pressure. GLP-1 agonists, such as liraglutide and semaglutide, are synthetic hormones that lower appetite and make individuals feel full. They are self-administered in a daily or weekly injection. Both drugs were first licensed to treat type 2 diabetes because they stimulate the secretion of insulin, which lowers blood sugar.
Both drugs for weight control and weight loss in those who are overweight or obese have recently been approved by the US Food and Drug Administration. People with extreme obesity, defined as a BMI of 40 or higher, or a BMI of 35 or higher combined with an obesity-related health condition such as hypertension, may benefit from weight loss surgery (also known as bariatric surgery or gastric bypass surgery). A study review on metabolic surgery is included in the statement. High blood pressure was resolved in 63% of persons who had metabolic surgery, and multiple trials showed that following surgery, participants used fewer blood pressure-lowering medications.
“Metabolic surgical procedures are evolving, and they are becoming less invasive and hazardous,” Hall explained. “Medications, metabolic surgery, or both, maybe explored in addition to a healthy diet and increased physical activity for certain individuals.”
The statement also raises concerns about the use of drugs and surgery to prevent and treat obesity-related hypertension, as well as research gaps. These concerns include whether these strategies will prevent organ damage, how effective they are for people who already have kidney disease or heart failure, and comparing the efficacy of medications, surgery, or a combination of the two to determine the best approach for long-term blood pressure reduction.
“There are many unresolved topics and many research opportunities that can help individuals live better and longer lives,” Hall added.
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