Intentional Weight Loss and Dose Reductions of Antihypertensive Medications: A Retrospective Cohort Study

Article (PDF Available)inCardioRenal Medicine 3(1):17-25 · April 2013with53 Reads
DOI: 10.1159/000347048 · Source: PubMed
Abstract
Though it is well known that weight loss tends to decrease blood pressure, the quantitative association between the magnitude of weight loss and the effect on the need for antihypertensive medications is not well studied. We analyzed this association among overweight and obese attendees at two outpatient weight management centers. Case records of patients with a body mass index >25 at baseline were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1,000 kcal/day deficit), a behavior modification plan, and a plan for increasing physical activity. The study cohort consisted of 100 participants, and the mean follow-up period was 15 ± 3.5 months. Significant weight loss (12.2 ± 3.4 kg) and systolic/diastolic blood pressure reductions (9.1/6.3 mm Hg) were observed by study exit. For 5, 10, and 15% weight loss, respectively, 3, 39, and 39% of the patients achieved at least 1 discontinuation of any antihypertensive medication, and 8, 42, and 21 dose reductions were achieved. Dose reductions or discontinuations occurred in all classes of antihypertensive medications with similar magnitudes of weight loss. Intentional weight loss can potentially result in dose reductions/discontinuations of antihypertensive medications. Our results should be validated with data from larger randomized controlled studies and may help to inform the conduct of a systematic review of prior randomized controlled trials that contain data on medication changes accompanying weight loss.
© 2013 S. Karger AG, Basel
1664–3828/13/0031–0017$38.00/0
Original Paper
Cardiorenal Med 2013;3:17–25
Intentional Weight Loss and Dose
Reductions of Antihypertensive Medications:
A Retrospective Cohort Study
Ghanshyam Palamaner Subash Shantha
a, g
Anita Ashok Kumar
a
Scott Kahan
b, f
Sang Yun Cheah
d
Lawrence J. Cheskin
c–e
Departments of
a
Epidemiology,
b
Health Policy and Management and
c
Health, Behavior
and Society, and
d
Department of International Health, Center for Human Nutrition, Johns
Hopkins Bloomberg School of Public Health, and
e
Johns Hopkins Weight Management
Center, Johns Hopkins University, Baltimore, Md. ,
f
Department of Health Policy, George
Washington University School of Public Health and Health Services, Washington, D.C. , and
g
The Wright Center for Graduate Medical Education, Scranton, Pa. , USA
Key Words
Weight loss · Obesity · Hypertension · Blood pressure · Antihypertensive agents
Abstract
Background: Though it is well known that weight loss tends to decrease blood pressure, the
quantitative association between the magnitude of weight loss and the effect on the need for
antihypertensive medications is not well studied. We analyzed this association among over-
weight and obese attendees at two outpatient weight management centers. Methods: Case
records of patients with a body mass index >25 at baseline were analyzed. The weight loss
intervention consisted of a calorie-restricted diet ( 1,000 kcal/day deficit), a behavior modi-
fication plan, and a plan for increasing physical activity. Results: The study cohort consisted
of 100 participants, and the mean follow-up period was 15 ± 3.5 months. Significant weight
loss (12.2 ± 3.4 kg) and systolic/diastolic blood pressure reductions (9.1/6.3 mm Hg) were ob-
served by study exit. For 5, 10, and 15% weight loss, respectively, 3, 39, and 39% of the patients
achieved at least 1 discontinuation of any antihypertensive medication, and 8, 42, and 21 dose
reductions were achieved. Dose reductions or discontinuations occurred in all classes of an-
tihypertensive medications with similar magnitudes of weight loss. Concl u s i o ns: Intentional
weight loss can potentially result in dose reductions/discontinuations of antihypertensive
medications. Our results should be validated with data from larger randomized controlled
studies and may help to inform the conduct of a systematic review of prior randomized con-
trolled trials that contain data on medication changes accompanying weight loss.
Copyright © 2013 S. Karger AG, Basel
Received: October 13, 2012
Accepted: January 7, 2013
Published online: February 15, 2013
Lawrence J. Cheskin, MD, FACP
Director, Johns Hopkins Weight Management Center
550 North Broadway, Suite 1001
Baltimore, MD 21205 (USA)
E-Mail lcheskin
@ jhsph.edu
www.karger.com/crm
DOI: 10.1159/000347048
18
Cardiorenal Med 2013;3:17–25
DOI: 10.1159/000347048
Shantha et al.: Intentional Weight Loss and Dose Reductions of Antihypertensive
Medications: A Retrospective Cohort Study
www.karger.com/crm
© 2013 S. Karger AG, Basel
Introduction
The National Health and Nutrition Examination Survey (NHANES) has shown that, in the
last decade, 35% of adult Americans were obese [body mass index (BMI; calculated as weight
in kilograms divided by height in meters squared) 30], and that the prevalence is expected
to increase in the years to come
[1] . Hypertension is common in obese individuals [2] . For
every 10-kg increase in body weight, mean systolic and diastolic blood pressures (SPB and
DPB) have been found to be increased by 3 and 2 mm Hg, respectively
[3] . Furthermore,
adults who are +20% overweight have an eight-fold greater incidence of hypertension
[4] .
Antihypertensive medications, though known to significantly decrease morbidity and
mortality among individuals with hypertension
[5–7] , are costly and often accompanied by
side effects.
The good news is that intentional weight loss significantly decreases both SPB and DBP
[8–10] . A modest weight loss of 5–10% of body weight typically decreases both SBP and DBP
by approximately 5 mm Hg
[10] , while a 15% weight loss will frequently decrease SBP by 10
mm Hg
[8] .
Though it is axiomatic that the reduction in blood pressure typically accompanying inten-
tional weight loss could result in decreased requirements for antihypertensive medications,
the quantitative association between the magnitude of weight loss and the expected dose
reductions or discontinuations of antihypertensive medications is not well studied. Estab-
lishing this quantitative association would be clinically useful in treating, counseling, and
motivating hypertensive, obese patients considering or attempting weight loss.
Thus, in this study of overweight and obese patients who achieved weight loss of variable
degrees, we attempted to establish the association between the magnitude of weight loss and
the expected dose reductions or discontinuations of antihypertensive medications.
Materials and Methods
Study Setting and Design
This retrospective cohort study was conducted in two university-based specialty outpatient weight
management clinics, the Johns Hopkins Weight Management Center in Baltimore, Md., and the George Wash-
ington Weight Management program in Washington, D.C. Institutional review board approval was obtained
for conducting the study. Informed consent was not obtained from the participants as the data were analyzed
anonymously per institutional review board guidelines.
Case records of patients with a BMI >25 at the time of enrollment into the two weight management
programs during the period from March 2008 to October 2011 were assessed for eligibility. Both were conve-
nience samples. Patients were sampled if they had a diagnosis of essential hypertension at the time of
enrollment into the programs, reported taking antihypertensive medications at the time of enrollment, and
had at least 1 documented dose reduction or discontinuation of at least 1 of the antihypertensive medications
before the study concluded in October 2011. Patients thus sampled formed the study cohort. The following
exclusion criteria were applied: no diagnosis of hypertension at the time of enrollment into the programs or
no documented dose reductions of antihypertensive medications (control group). Patients receiving
treatment with 4 antihypertensive medications were excluded both from the study cohort and the control
group as they present a more severe form of hypertension and are less likely to respond to weight loss. All
excluded patients formed the excluded cohort.
Baseline Data Collection
Demographic data (age, gender, and race/ethnicity), cardiovascular risk factors (smoking, diabetes, and
hypertension), medication history (antidiabetic medications, antihypertensive medications, and lipid-
lowering drugs), clinical parameters (height, weight, SBP, and DBP), and laboratory parameters (fasting
glucose, HbA1C, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol,
and triglycerides) were collected for the total cohort. BMI was calculated as per standard guidelines
[11] .
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DOI: 10.1159/000347048
Shantha et al.: Intentional Weight Loss and Dose Reductions of Antihypertensive
Medications: A Retrospective Cohort Study
www.karger.com/crm
© 2013 S. Karger AG, Basel
Metabolic syndrome was determined using the National Cholesterol Education program (NCEP ATP III)
guidelines
[12] . Hypertension was identified by physician diagnosis. All patients in our study had essential
hypertension. There were none with secondary forms of hypertension. The severity of hypertension was
classified using the Joint National Committee (JNC)-7 criteria
[13] .
Patient Follow-Up and Weight Management Intervention Details
The weight loss intervention protocols followed at the two participating clinics were similar and
consisted of team-based, comprehensive evaluation and treatment for weight loss. The study participants
had physician visits and evaluations on average twice a month. The baseline visit consisted of a physician-
conducted medical history and physical examination, blood tests (as described above), and detailed dietary,
behavioral, and exercise evaluations. Treatment was individualized but typically consisted of an approxi-
mately 1,000-kcal/day energy deficit diet, a behavior modification plan, and a plan for increasing physical
activity utilizing both aerobic exercise and strength training. The diet composition was individualized but
was generally low fat and initially mildly carbohydrate restricted as well. Meal replacements were often
utilized as part of the diet prescription to improve adherence and increase weight loss. Depending on
treatment response, the intervention was further tailored to address individual patient needs. The decision
to alter the dose of or discontinue antihypertensive medications was based on the clinical judgment of the
treating physicians. Factors considered in deciding dose reductions included symptoms and signs suggestive
of orthostatic hypotension, magnitude of weight loss, blood pressure control, and the patient’s compliance
to the weight management protocol.
O u t c o m e s
The outcomes that were determined included the number (%) of patients achieving 5, 10, and 15%
weight loss, time taken to reach those goals, mean SBP/DBP, mean SBP/DBP reduction, number of discon-
tinuations, and number of dose reductions of antihypertensive medications associated with 5, 10, and 15%
weight loss, and weight and blood pressure at study exit.
Patients exited the cohort if they required an increase in dose or restarting of an antihypertensive medi-
cation after the initial dose reduction or discontinuation (defined as relapse) or were administratively
censored at study conclusion. The decision to restart or increase the dose of antihypertensive medications
was individualized by the treating physicians, taking into account blood pressure as monitored over 2–3
consecutive visits. The time between the visit when the last documented medication dose reduction occurred
until the visit when the patients relapsed was defined as time to relapse.
Statistical Analysis
Data were expressed as number (%) for categorical variables and as mean ± standard deviation for
continuous variables. Two-group comparisons were performed using Student’s t test and χ
2
test, as appro-
priate.
Baseline characteristics, weight changes, blood pressure changes, and the outcome variables described
above were compared between the study cohort and excluded cohort participants who failed to achieve
dose reductions despite success with weight loss (control group). Then, multiple linear regression and
multiple logistic regression analyses were performed to identify the association between percent weight
loss (centered at 5%) and the mean percent dose reductions of antihypertensive medications (for multiple
linear regression) and discontinuation of any antihypertensive medications (coded as dichotomous variable
for logistic regression) for the study cohort [adjusted for age, gender, JNC class, baseline BMI, number of
antihypertensive medications, and type 2 diabetes mellitus (DM) diagnosis]. Multiple logistic regression
analyses were also performed to identify factors associated with relapse using the study cohort (adjusted
for age, gender, JNC class, baseline BMI, number of antihypertensive medications, and type 2 DM diagnosis).
For all these analyses, individuals treated with 4 antihypertensive medications (2 patients) were excluded
as they present a more severe form of hypertension and hence were less likely to respond to weight loss.
Akaike’s information criteria and Hosmer-Lemeshow goodness-of-fit were used as needed while deter-
mining the variables to be included in the model
[14] . A p value <0.05 was considered statistically signif-
icant. All analyses were performed using Stata 11.0 statistical software (StataCorp, College Station, Tex.,
USA).
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DOI: 10.1159/000347048
Shantha et al.: Intentional Weight Loss and Dose Reductions of Antihypertensive
Medications: A Retrospective Cohort Study
www.karger.com/crm
© 2013 S. Karger AG, Basel
Results
In total, 179 patient records (107 from Johns Hopkins and 72 from George Washington)
were identified and reviewed. Of these, 77 (43%) were excluded (excluded cohort) because
of the following exclusion criteria: no diagnosis of hypertension (30, 17%) or no documented
dose reductions of antihypertensive medications despite success at weight loss (control
group; n = 47, 26%). The remaining 102 (57%) patients formed the study cohort. Further, 2
patients from the study cohort and 10 patients from the control group were excluded as they
Table 1. Baseline characteristics of the study cohort and the control group
Variables Study cohort Control group p value
(n = 100) (n = 37)
Age, years 51.6
± 8.9 55.7 ± 10.4 0.221
Males 54 (54) 22 (59) 0.055
Caucasians 72 (72) 27 (73) 0.173
African-Americans 28 (28) 10 (27) 0.220
Current smoking 20 (20) 8 (22) 0.091
Mean BMI 36.1
± 5.5 35.7 ± 4.4 0.337
BMI 25
30 25 (25) 8 (22) 0.069
BMI 31
40 53 (53) 25 (68) 0.024
BMI ≥41 22 (22) 4 (11) 0.045
DM diagnosis 57 (58) 16 (43) 0.041
HbA1C, % 8.2
± 1.6 8.1 ± 1.8 0.115
HTN diagnosis 102 (100) 37 (100) 1.000
Mean duration of hypertension, years 9
± 3.5 9 ± 4.5 0.368
Mean SBP, mm Hg 144
± 8.9 140 ± 14.1 0.319
Mean DBP, mm Hg 94
± 4.2 93 ± 2.9 0.263
Pre-HTN 25 (25) 3 (8) 0.022
JNC stage I HTN 70 (70) 15 (41) 0.017
JNC stage II HTN 5 (5) 19 (51) 0.011
Mean TC, mmol/l 5.2
± 1.4 5.2 ± 1.1 0.226
Mean LDL-C, mmol/l 4.2
± 1.2 4.1 ± 1.7 0.317
Mean HDL-C, mmol/l 1.2
± 0.4 1.0 ± 0.4 0.071
Mean TGL, mmol/l 1.7
± 0.5 1.7 ± 0.4 0.118
Metabolic syndrome 55 (55) 29 (78) 0.014
Anti-DM drugs 57 (57) 16 (43) 0.046
Lipid-lowering drugs 75 (75) 30 (81) 0.069
Antihypertensive drugs 100 (100) 37 (100) 1.000
ACE-I 49 (49) 8 (22) 0.028
ARB 68 (68) 6 (16) 0.013
BB 23 (23) 3 (8) 0.025
CCB 22 (22) 3 (8) 0.012
Diuretics 38 (38) 10 (27) 0.043
Treated with 1 antihypertensive drug 23 (23) 4 (11) 0.047
Treated with 2 antihypertensive drugs 64 (64) 10 (27) <0.001
Treated with 3 antihypertensive drugs 13 (13) 23 (62) 0.010
Values represent n (%) or mean ± SD.
TC = Total cholesterol; LDL-C = low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein
cholesterol; TGL = triglycerides; ACE-I = angiotensin-converting enzyme inhibitors; ARB = angiotensin
receptor blockers; BB = beta-blockers; CCB = calcium channel blockers.
Control group: hypertensive patients with no documented dose reductions of antihypertensive medica-
tions despite success in weight loss.
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Shantha et al.: Intentional Weight Loss and Dose Reductions of Antihypertensive
Medications: A Retrospective Cohort Study
www.karger.com/crm
© 2013 S. Karger AG, Basel
were receiving treatment with 4 antihypertensive medications. Hence, the final analytical
sample size for the study cohort was 100 (56%) patients, and the control group consisted of
37 (21%) patients. The mean duration of hypertension among the study cohort was 9 ± 3.5
years. Demographic characteristics, medication details, and patient follow-up information
are shown in table 1 and in online supplementary tables S1 and S2 (for all online suppl.
material, see www.karger.com/doi/10.1159/000347048).
The study cohort showed a significant weight loss (12.2 ± 3.4 kg) and significant SBP/
DBP reductions (9.1/6.3 mm Hg), with 91 (89%), 46 (46%), and 18 (18%) of the patients
achieving 5, 10, and 15% weight loss, respectively, by the time of study exit ( table 2 ). In
comparison, the 37 participants from the excluded cohort who did not achieve dose reduc-
tions despite some weight loss (control group) presented nonsignificant weight losses (3.9 ±
3.1 kg) and nonsignificant SBP/DBP reductions (2.5/2 mm Hg), with only 6 (22%) achieving
5% weight loss and none achieving 10 or 15% weight loss.
In the study cohort, for 5, 10, and 15% weight loss, 3, 39, and 39% in the respective
groups achieved at least 1 discontinuation of any antihypertensive medication ( table 2 ). Also,
for 5, 10, and 15% weight loss, 8, 42, and 21 dose reductions were observed in the respective
groups ( table 2 ). Dose reductions or discontinuations occurred in all classes of antihyper-
tensive medications with similar magnitudes of weight loss (online suppl. table S3). Figures
1 and 2 detail blood pressure and medication changes of the study cohort with weight loss.
Additionally, 38 (38%) of the patients in the study cohort relapsed, with a weight regain
of 8.3 ± 3.9 kg and an increase in SBP/DBP of 6.5 ± 2.5/3.5 ± 2 mm Hg. Though the blood
pressure increases of relapsing patients were significantly higher, the weight regains were
not significantly different from their weight at their last dose reduction.
For every 5% weight loss, the patients in the study cohort achieved 36% reductions in
their antihypertensive medication dose and had a 29% higher probability of stopping one of
their antihypertensive medications ( table 3 ). Factors such as age, gender, JNC class, baseline
BMI, number of antihypertensive medications, and DM diagnosis were not associated with
relapse (online suppl. table S4).
140
135
130
125
SBP (mm Hg)
0 5 10 15 20
100
95
90
80
DBP (mm Hg)
0 5 10 15 20
% weight loss % weight loss
Fig. 1. SBP and DBP drop with % weight loss (study cohort). The x-axis represents % weight loss the study
cohort participants achieved during the follow-up period, and the y-axis represents changes in SBP and DBP.
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DOI: 10.1159/000347048
Shantha et al.: Intentional Weight Loss and Dose Reductions of Antihypertensive
Medications: A Retrospective Cohort Study
www.karger.com/crm
© 2013 S. Karger AG, Basel
Discussion
In this sample of overweight and obese adults, we observed that, with intentional weight
loss of 5, 10, and 15% of starting body weight, 3, 38, and 39% of the patients, respectively,
could achieve at least 1 discontinuation of an antihypertensive medication, and 8, 42 and 78
dose reductions of at least 1 antihypertensive medication were achieved.
0
0.2
0.4
0.6
0.8
1.0
Probability of dose reduction
of any antihypertensive medication
0
0.05
0.10
0.15
0.20
Density
3 6 9 12 15 18 21 24 27
% weight loss
Fig. 2. Probability of dose reduc-
tion of antihypertensive medica-
tion with weight loss. The x-axis
represents % weight loss, and the
y-axis represents the probability
for dose reductions of antihyper-
tensive medications. Diamonds
represent each dose reduction
that was observed, and the verti-
cal bars represent the distribu-
tion density of dose reductions
with weight loss.
Table 3. Association between percentage weight loss (every 5%) and dose reductions/discontinuation of
antihypertensive medications
Mean % dose reduction
1
Discontinuation of antihypertensive drugs
2
mean % 95% CI p value odds ratio 95% CI p value
Study cohort* 36 11
79 0.036 1.29 1.04 – 1.85 0.037
* Adjusted for age, gender, type 2 DM diagnosis, BMI, JNC class, and number of antihypertensive drugs.
1
Linear regression analysis.
2
Logistic regression analysis.
Table 2. Weight loss and antihypertensive drug dose reduction/discontinuation (study cohort n = 100)
5% weight loss 10% weight loss 15% weight loss
Patients, n (%) 91 (91) 46 (46) 18 (18)
Time taken, weeks 5
± 2.5 7 ± 29 ± 2
SBP, mm Hg 136
± 8 135 ± 4.6 130 ± 4.5
SBP reduction, mm Hg 4.5
± 2 8.1 ± 3.0 12.7 ± 5
DBP, mm Hg 91
± 489 ± 3.0 87 ± 5.1
DBP reduction, mm Hg 2.4
± 0.9 4.5 ± 2.2 7.4 ± 2.7
Discontinuations, n (%) 3 (3) 18 (39) 7 (39)
Dose reductions, n 8 42 21
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DOI: 10.1159/000347048
Shantha et al.: Intentional Weight Loss and Dose Reductions of Antihypertensive
Medications: A Retrospective Cohort Study
www.karger.com/crm
© 2013 S. Karger AG, Basel
The independent association between intentional weight loss and blood pressure
reduction is well established
[8–10] . The mechanism for this effect likely stems from the fact
that obesity is typically a high-catecholamine and high-renin state
[15–17] . Weight loss, by
decreasing catecholamine, renin, and aldosterone levels, lowers blood pressure by decreasing
vascular tone, reducing myocardial contractility, ameliorating the high-output state, reducing
the intravascular fluid volume, and promoting natriuresis
[15–17] . Of note, weight loss can
thus potentially substitute for the mechanisms of action of all existing classes of antihyper-
tensive medications. True to this hypothesis, with weight loss of similar magnitudes, we
observed that it was possible to reduce the doses of antihypertensive medications of any
class.
Most of the hormonal changes involved in obesity-associated hypertension correlate
with the level of adiposity, and the degree of mitigation of these hormonal changes correlates
with the magnitude of weight loss
[18, 19] . This may be why participants in the excluded
cohort with nonsignificant weight loss had poorer blood pressure reduction and thus could
not achieve reductions in dosage of their antihypertensive medications (control group).
It is noteworthy that over a third (37%) of the patients in the study cohort relapsed from
their reductions in and/or discontinuations of antihypertensive medications. Hypertension,
being a chronic, progressive disease, usually relapses when medication discontinuation is
attempted
[18, 19] . Our analysis of patient factors associated with relapse revealed no signif-
icant associations. However, among patients who relapsed, though on average they had
experienced some weight regain, the weight at the time of relapse was not significantly
different from the weight at their last dose reduction. Thus, it is possible that the natural
history of hypertension progression was being observed, resulting in relapse, or that even
the modest, not statistically significant level of weight regain experienced may have partly
reinstated the hormonal milieu, discussed earlier, that fosters hypertension among obese
individuals.
Limitations
We observed significantly greater magnitudes of weight loss (12.2 kg by 15 months of
follow-up) and blood pressure reductions (SBP/DBP: 9.1/6.3 mm Hg at 15 months) compared
to typical randomized controlled weight loss trials (weight loss: 4–6 kg within 12–15 months
of follow-up, SBP/DBP: 3–4/2–3 mm Hg)
[20, 21] . It is thus possible that confounding due to
unknown factors may have played a role. Or else, surveillance bias is possible due to the
intensity of weight loss intervention being individualized and the decision to reduce the dose
being subjective and at the discretion of the treating physicians. Additionally, the small sample
size limited us from analyzing associations specific to individual medications and BMI cate-
gories. Finally, the study’s retrospective cohort design limited our data to whatever was
recorded in the patient records.
Conclusions
We found that intentional weight loss was frequently an effective intervention for
achieving discontinuations and dose reductions of all classes of antihypertensive medica-
tions. Validation of the results of our study with data from larger randomized controlled trials
is needed. Since a report of the association between the magnitude of weight loss and dose
reductions of antihypertensive medications is novel, these findings can help to inform the
conduct of a systematic review using data from prior randomized controlled trials that have
24
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DOI: 10.1159/000347048
Shantha et al.: Intentional Weight Loss and Dose Reductions of Antihypertensive
Medications: A Retrospective Cohort Study
www.karger.com/crm
© 2013 S. Karger AG, Basel
evaluated interventions for weight loss. Such information, if confirmed, can add a quantitative
aspect to the oft-cited advice health-care providers give to obese, hypertensive patients: ‘lose
weight, and you will reduce your blood pressure and need for medications’.
Acknowledgments
We thank Mr. Rohit Joshua Samson and Mr. Nelson David Boddu for their help with the chart review. Dr.
Ghanshyam Palamaner Subash Shantha, MD, MPH, is supported in part by a NIH/NHLBI T32HL007024
Cardiovascular Epidemiology Training Grant for his research training at the Johns Hopkins Bloomberg
School of Public Health.
Disclosure Statement
Lawrence Jay Cheskin serves as a consultant and stockholder for Medifast, Inc. and Vivus, Inc. All other
authors have no conflicts of interest to declare.
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20 Appel LJ, Clark JM, Yeh HC, Wang NY, Coughlin JW, Daumit G, et al: Comparative effectiveness of weight-loss
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  • [Show abstract] [Hide abstract] ABSTRACT: Overweight patients with uncomplicated essential hypertension were followed up biweekly for six months: 24 not receiving antihypertensive-drug therapy (Group I) and 83 on regular but inadequate (despite drug manipulation) antihypertensive-drug therapy (Group II). All patients in Group I and 57 randomly selected patients from group II (IIa) participated in a weight-reduction program. The remaining 26 from Group II (IIb) did not receive a dietary program. Salt intake was in the normal range in all three groups. All patients on the dietary program lost at least 3 kg (mean, 10.5 kg), and all but two showed a meaningful reduction in blood pressure; 75 per cent of Group I and 61 per cent of Group IIa returned to normal blood pressure. The weight and blood-pressure reductions were highly significant (P less than 0.001), were present in both sexes and all ages, and were directly associated. In Group IIb, no significant change in blood pressure or weight occurred (P greater than 0.30).
    Article · Feb 1978
  • Article · Jul 1978
  • [Show abstract] [Hide abstract] ABSTRACT: In the nationwide Community Hypertension Evaluation Clinic screening of more than 1 million people, the group classifying itself as overweight had prevalence rates of hypertension 50% to 300% higher than other screenees. Frequency of hypertension in overweight persons aged 20 to 39 years was double that of normal weight and triple that of underweight persons. Among those aged 40 to 64 years, the overweight group had a 50% higher hypertension prevalence rate than the normal-weight group and 100% higher than the underweight group. With each higher degree of blood pressure elevation, relative frequency of hypertension with overweight was larger. Thus this study confirms, in the largest group surveyed to date, similar findings in previous cross-sectional surveys. It is also consistent with data from longitudinal and intervention studies on the importance of overweight in relation to hypertension. (JAMA 240:1607-1610, 1978)
    Article · Nov 1978
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