Pharmacologic and Nutritional Treatment of Mild Hypertension: Changes in Cardiovascular Risk Status

Oberman, Albert; Wassertheil‐Smoller, Sylvia; Langford, Herbert G.; Blaufox, M. Donald; Davis, Barry R.; Blaszkowski, Thomas P.; Zimbaldi, Neal; Hawkins, C. Morton

doi:10.7326/0003-4819-112-2-89

Cited by 70 publications

(22 citation statements)

References 7 publications

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“…Systolic and diastolic reductions in blood pressure were À0.52 and À0.41 mm Hg, respectively, when expressed per kilogram of weight loss. These reductions were similar to those observed by other authors, [38][39][40][41] although lower than those FPG (mg 100 ml À1 ) 9 1 . 3 ± 6.9 88.4 ± 5.7 86.1 ± 4.8 91.5 ± 7.0 88.7 ± 6.0 86.2 ± 4.8 FPI (mU ml À1 ) 8 .…”

Section: Discussionsupporting

confidence: 80%

Effect of body weight loss and normalization on blood pressure in overweight non-obese patients with stage 1 hypertension

et al. 2010

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We evaluated the effects of body weight (BW) loss on blood pressure (BP) in overweight non-obese patients with stage 1 hypertension. We enrolled 376 overweight (body mass index (BMI) X25 and o30 kg m À2 ) stage 1 hypertensive patients in this prospective 12-month trial. Each patient received tailored, low caloric dietary advice. After 6 months, patients with a BW reduction o5% were excluded. Body weight, BMI, BP, fasting plasma glucose (FPG), fasting plasma insulin (FPI), leptin (pL), renin and aldosterone levels were evaluated at baseline and after 6 and 12 months. In 222 patients who completed the study, a mean weight reduction of 8.1 kg reduced systolic blood pressure (SBP) by 4.2 mm Hg and diastolic blood pressure (DBP) by 3.3 mm Hg (Po0.05), which was accompanied by a significant decrease in FPI, pL and aldosterone levels (Po0.05). Larger SBP/DBP reductions were observed in 106 patients with normalized BMI (À5/À4.5 mm Hg, Po0.01) compared with the 116 patients who did not become normalized (À3.3/À1.6 mm Hg). The former also presented with greater decreases in FPG, FPI, pL, renin and aldosterone levels. Of the 106 patients who had normalized BMI, 52 also had normalized BP. Clinical and metabolic characteristics of these patients were similar to those of the 56 patients who did not have normalized BP. In overweight, mild hypertensive patients, weight loss was effective in reducing BP and in reversing some endocrinologic alterations associated with being overweight. Half of the patients who had normalized BMI also had normalized BP, which could indicate that these patients essentially did not have a form of hypertension but that these effects were instead secondary to being overweight. Keywords: blood pressure; overweight; weight-loss INTRODUCTION Excessive body weight (BW), in particular abdominal obesity, increases the risk for cardiovascular disease, stroke, type 2 diabetes, hypertension, lipoprotein disorders, osteoarthritis, certain types of cancers and total mortality. 1-5 An escalating epidemic of overweight (body mass index (BMI) X25 and o30 kg m À2 ) and obesity (BMI 430 kg m À2 ), is affecting both industrialized and many developing countries in the world, and constitutes a major public health problem. 4,6,7 In particular, in the United States, the prevalence of obesity was estimated at 32% of the population. Being overweight was even more prevalent, representing 42% of men and 28% of women, of whom 34 and 39%, respectively, had high blood pressure (BP). 8,9 The coexistence of hypertension and excessive BW greatly enhances cardiovascular risk. 2,10 Recent recommendations suggest the use of stratification tables to calculate the percentage of increased cardiovascular risk in patients with hypertension and excess BW or obesity. 11 The mechanisms underlying hypertension in subjects with excessive BW

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Section: Discussionsupporting

confidence: 80%

Effect of body weight loss and normalization on blood pressure in overweight non-obese patients with stage 1 hypertension

et al. 2010

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“…If intermediate measurements were not reported, then the total intervention period was used. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Different types of weight intervention could have been examined within the same trial, ie, energy restriction, increased physical activity, or the combined intervention. When this was the case, these interventions were analyzed as separate strata.…”

Section: Data Abstractionmentioning

confidence: 99%

Influence of Weight Reduction on Blood Pressure

et al. 2003

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Abstract-Increased body weight is a strong risk factor for hypertension. A meta-analysis of randomized controlled trials was performed to estimate the effect of weight reduction on blood pressure overall and in population subgroups. 2 ) for American adults aged 20 to 74 years increased from 13.4% to 30.9%. In 2000, the prevalence of overweight (BMI Ն25 kg/m 2 ) for American adults was 64.5%. 3 Weight loss has been proposed as an effective, nonpharmacologic means for the primary prevention of hypertension. 4 An early meta-analysis by Staessen et al 5 in 1988 showed a reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) of Ϫ2.4 and Ϫ1.5 mm Hg per kilogram weight loss, respectively.Targeted weight loss interventions in population subgroups might be more effective for the prevention of hypertension than a general-population approach because of interindividual differences in BP and body weight. In the present meta-analysis of 25 randomized controlled trials (RCTs), both the overall and subgroup effects of body weight reduction on BP were assessed. This stratified meta-analysis could strengthen the scientific basis for weight control as an important ingredient of hypertension control programs in the community and in individual patients. Methods Selection of StudiesSystematic literature searches in electronic databases (Cab Abstract, Current Contents, FSTA, and MEDLINE Advanced) were conducted for RCTs of weight reduction and BP by using the search phrase (overweight OR weight reduction OR obes* OR weight OR diet*) AND (hypertension OR blood pressure) AND (trial OR intervention OR random* OR study) as title words or MeSH terms. Article reference lists were examined for additional articles.Trials that fulfilled the following criteria were eligible for metaanalysis: (1) an RCT design, (2) published after 1966, (3) conducted in humans, (4) written in English, and (5) nonpharmacologic reduction of body weight. A total of 97 articles was identified, of which 72 were excluded on the basis of the predefined criteria (literature list of excluded trials is available from the authors); ie, they did not fulfill the inclusion criteria (nϭ21), the intervention period was Ͻ8 weeks (nϭ2), there were co-interventions from which the effect of weight loss could not be separated (nϭ28), inappropriate or missing BP data (nϭ5), study objective was not weight reduction (nϭ4), or overlapping data with other publication(s) (nϭ12). Figure 1 shows the number of studies that were identified and excluded at different stages of the selection process. A total of 25 trials 6 -30 proved eligible for this meta-analysis.

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“…2,3 Este manejo es efectivo para disminuir las cifras de presión arterial de las personas con niveles normales en límites altos 4 y en los pacientes con hipertensión. [5][6][7][8] Al evaluar el impacto de la enfermedad y del tratamiento, es esencial medir y evaluar el grado de alivio de los síntomas, mismos que podrían traducirse en una mejoría de la calidad de vida (CV), 9 considerada esta última como la sensación de bienestar físico y de satisfacción emocional, psíquica y social del individuo. 10 Para evaluar la CV se emplean instrumentos que abarcan diferentes dominios relacionados con los valores subjetivos del paciente, determinados a su vez por los contextos sociales, culturales y económicos, que también se ven afectados por la enfermedad o por el tratamiento mismo.…”

Section: Introductionunclassified

Efecto de una intervención educativa en la calidad de vida del paciente hipertenso

Barrón-Rivera¹,

Torreblanca-Roldán²,

Sánchez-Casanova³

et al. 1998

Salud pública Méx

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ARTÍCULO ORIGINAL La intervención educativa en la calidad de vida del hipertensoEfecto de una intervención educativa en la calidad de vida del paciente hipertenso Adalberto Jorge Barrón-Rivera, M.C., (1) Federico Luis Torreblanca-Roldán, M.C., (2) Landy Isabel Sánchez-Casanova, M.C., (2) Miguel Martínez-Beltrán, M.C. (2) entre 18 y 65 años de edad del mundo. Es un factor de riesgo importante para las enfermedades cardiovasculares, cerebrovasculares, renales y vasculares periféricas. 1El manejo no farmacológico, es decir, la modificación del estilo de vida está indicada como medida inicial, o bien, como suplementaria al manejo con medicamentos para el paciente con hipertensión arterial; incluye la disminución en la ingesta de sodio, alcohol y grasas saturadas, así como el incremento de la actia hipertensión arterial es una patología crónica degenerativa presente en 20% de las personas de Efecto de una intervención educativa en la calidad de vida del paciente hipertenso.Salud Publica Mex 1998;40:503-509. ResumenObjetivo. Evaluar el efecto de una intervención educativa sobre la calidad de vida del paciente hipertenso. Material y métodos. Se estudiaron 150 adultos hipertensos en un primer nivel de atención mediante un ensayo clínico aleatorizado a dos grupos. El grupo experimental fue objeto de una intervención educativa sobre hipertensión y la repercusión del estilo de vida en el control de tal enfermedad. El grupo testigo no recibió intervención. En ambos grupos se determinó la calidad de vida mediante una escala análoga visual, antes y seis meses después de la intervención educativa. Los datos se analizaron mediante las pruebas t-pareada y Wilcoxon. Resultados. El grado de mejoría, en relación con la fuerza física y el estado anímico, difirió entre grupos (p< 0.05); en las áreas correspondientes a la capacidad de pensamiento, la convivencia social-familiar, la percepción de calidad de vida y el funcionamiento sexual, sólo el grupo experimental mostró cambios (p< 0.05). Conclusiones. La intervención educativa es efectiva para modificar la calidad de vida del paciente hipertenso.

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Pharmacologic and Nutritional Treatment of Mild Hypertension: Changes in Cardiovascular Risk Status

Cited by 70 publications

References 7 publications

Effect of body weight loss and normalization on blood pressure in overweight non-obese patients with stage 1 hypertension

Effect of body weight loss and normalization on blood pressure in overweight non-obese patients with stage 1 hypertension

Influence of Weight Reduction on Blood Pressure

Efecto de una intervención educativa en la calidad de vida del paciente hipertenso

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