BP Changes in Obese Hypertensive Subjects During Rapid Weight Loss

Maxwell, Morton H.; Kushiro, Toshio; Dornfeld, Leslie; Tuck, Michael L.; Waks, Abraham U.

doi:10.1001/archinte.1984.00350200073012

Cited by 68 publications

(12 citation statements)

References 20 publications

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“…Net changes in blood pressure were all in a negative direction, except in the trial of Puska et al 22 and for diastolic blood pressure in Maxwell et al 24 The reductions were significant in six trials for systolic and nine trials for diastolic blood pressure. Two trials reported no data on confounders 25 -29 ; six provided data on changes in weight, eight on potassium, three on alcohol, and one on fat intake.…”

Section: Supplement I Hypertensionmentioning

confidence: 88%

An overview of randomized trials of sodium reduction and blood pressure.

et al. 1991

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To test for effects on systolic and diastolic blood pressure and to provide precise estimates of their magnitude, we conducted an overview of randomized clinical trials that aimed to reduce the intake of sodium in human subjects. We excluded from pooled analyses trials with confounded designs, those that compared intake levels beyond the usual range in the population, and those without published reports. Two reviewers abstracted information in duplicate and differences were reconciled. Twenty-three trials with outcome data from an aggregate of 1,536 subjects were included. Data were pooled both separately for hypertensive and nonnotensive subjects and for all trials combined. With the use of sample size weighting, blood pressure reductions (net of controls) were 4.9±13/2.6±0.8 mm Hg (systolic and diastolic, respectively, with 95% confidence limits) in hypertensive subjects and 1.7 ±1.0/1.0 ±0.7 mm Hg in nonnotensive subjects. The combined blood pressure reductions were 2.9±0.8/1.6±0.5 mm Hg. These changes were associated with mean reduction of urinary sodium excretion ranging from 16 to 171 mmol/24 hr for individual trials. A dose-response relation across trials was found, both in nonnotensive and in hypertensive subjects. These results indicate that sodium reduction lowers mean blood pressure in both hypertensive and nonnotensive individuals for periods of at least several months. The findings are highly consistent with results of observational epidemiological studies and have implications for preventive strategies of blood pressure control. {Hypertension 1991;17[suppl I]:I-27-I-33) R andomized intervention trials, properly conducted, provide the best test of an effect of prophylactic or therapeutic treatments. 1 Although the blood pressure effects of reducing dietary sodium have been studied since early in the century, 2 randomized trials have been reported only within the past 17 years, 3 largely the past 10 years. Trials have both increased in frequency and become more varied and complex in design. These changes reflect the importance of the question for public health and biology but also pose a challenge for summarizing and interpreting results. Several reviews have been published in recent years, 4 -5 but they did not present pooled analyses of all relevant trials to the time of the reviews, and several trials have since been completed. We favor pooling as part of a review because it formalizes the objective of including all relevant trials and an explicit method of combining their results. It also furnishes a quantitative estimate of the effect, which

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Section: Supplement I Hypertensionmentioning

confidence: 88%

An overview of randomized trials of sodium reduction and blood pressure.

et al. 1991

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“…7,8,15,16 Limited information is available for the maintenance of these improvements in risk factors during follow-up. 17 In our study, one-third of the weight lost was regained during the one-year follow-up, and improvements were sustained in serum triglycerides, glucose, waist circumference and night-time and 24 h ABPs.…”

Section: Discussionmentioning

confidence: 99%

“…18,19 However, the importance of sodium restriction during energy restriction has been questioned by others, 20 especially during weight loss with a VLCD. 7,21 Weight loss studies have seldom reported 24 h ABP monitoring results. Thus, it is not possible to compare our results directly with earlier studies.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Weight loss has bene®cial effects on other risk factors as well. 5,6 During weight loss with a very-low-calorie diet (VLCD), a rapid decrease in BP, both in hypertensive and normotensive, obese subjects has been reported previously, 7,8 and this seems to be independent of sodium intake. 7 The role of sodium restriction on BP during less severe energy restriction is controversial.…”

Section: Introductionmentioning

confidence: 86%

“…5,6 During weight loss with a very-low-calorie diet (VLCD), a rapid decrease in BP, both in hypertensive and normotensive, obese subjects has been reported previously, 7,8 and this seems to be independent of sodium intake. 7 The role of sodium restriction on BP during less severe energy restriction is controversial. 9 Compared to casual BPs, more reproducible pressures can be measured by non-invasive 24 h ambulatory blood pressure (ABP) monitoring.…”

Section: Introductionmentioning

confidence: 86%

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Weight loss with very-low-calorie diet and cardiovascular risk factors in moderately obese women: One-year follow-up study including ambulatory blood pressure monitoring

1998

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OBJECTIVE: The bene®cial effects of weight loss with a very-low-calorie diet (VLCD) on cardiovascular risk factors have been reported at the end of energy restriction. As the effects, especially on blood pressure, may not remain constant during weight maintenance, we studied the longer-term effects of weight loss on 24 h ambulatory blood pressure (ABP), lipids, glucose and insulin. DESIGN: Prospective study of a 17-week weight loss programme containing an eight-week VLCD period and followup visit at one-year. SUBJECTS: Twenty-nine moderately obese, normotensive or mildly hypertensive women. The mean AE s.d. body mass index (BMI) was 36.0 AE 2.6 kg/m 2 and mean age 40.3 AE 8.3 y. RESULTS: In the last week of the VLCD, the mean (s.d.) weight loss was 12.4 AE 3.3 kg (P`0.001), at the end of the programme 15.1 AE 4.4 kg (P`0.001 vs baseline), and at one-year follow-up 10.7 AE 7.6 kg (P`0.001 vs baseline). Mean 24 h ABP decreased 8.0/4.6 mmHg (P`0.001 for both) on the last week of the VLCD, at the end of the programme, the systolic ABP decrease was 4.7 mmHg (P`0.01 vs baseline) and diastolic 2.1 mmHg (not statistically signi®cant (NS) vs baseline). At one-year follow-up, the mean systolic ABP decrease was 4.1 mmHg (P`0.01 vs baseline) and mean diastolic 3.0 mmHg (P`0.05 vs baseline). Sodium excretion decreased 55 mmol/24 h in the last VLCD week (P`0.01) and returned to baseline after that. At the one-year follow-up, bene®cial changes, compared with baseline, were observed in mean serum glucose (À0.28 mmol/l, P`0.05), triglyceride (À0.35 mmol/l, P`0.01) and HDL cholesterol (0.16 mmol/l, P`0.001). CONCLUSIONS: This weight loss programme with a VLCD enabled obese subjects to lose weight and decrease cardiovascular risks. Despite some regain in weight during follow-up, the bene®cial effects were overall maintained over the year. Sodium intake tended to increase during follow-up. Information on sodium restriction should be included in weight loss programmes.

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Sodium and Hypertension

Houston¹

1986

Arch Intern Med

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BP Changes in Obese Hypertensive Subjects During Rapid Weight Loss

Cited by 68 publications

References 20 publications

An overview of randomized trials of sodium reduction and blood pressure.

An overview of randomized trials of sodium reduction and blood pressure.

Weight loss with very-low-calorie diet and cardiovascular risk factors in moderately obese women: One-year follow-up study including ambulatory blood pressure monitoring

Sodium and Hypertension

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