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. 1982 Apr;72(4):359–368. doi: 10.2105/ajph.72.4.359

The experimental evidence for weight-loss treatment of essential hypertension: a critical review.

M F Hovell
PMCID: PMC1649894  PMID: 7039371

Abstract

The empirical evidence concerning the therapeutic effects of weight loss for hypertension treatment was reviewed. Interventions were critically reviewed for strength of measures and experimental design. Six of 21 intervention studies proved to be methodologically strong. However, only one study was considered a randomized clinical trial, testing the combined effects of weight reduction and pharmacological treatment of hypertension. Average blood pressure decrease obtained from the methodologically strongest studies was -21 mmHg and -13 mmHg, for systolic and diastolic measures, respectively. This magnitude change suggests that weight loss may be a clinically and statistically significant treatment. Confounding and bias variables, such as adherence to diet, medication, salt consumption, etc., were discussed and future areas of research were outlined. It was concluded that weight loss appears to be an effective and safe treatment of hypertension.

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Selected References

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  1. Abramson E. E. Behavioral approaches to weight control: an updated review. Behav Res Ther. 1977;15(4):355–363. doi: 10.1016/0005-7967(77)90067-5. [DOI] [PubMed] [Google Scholar]
  2. Ashley F. W., Jr, Kannel W. B. Relation of weight change to changes in atherogenic traits: the Framingham Study. J Chronic Dis. 1974 Mar;27(3):103–114. doi: 10.1016/0021-9681(74)90079-4. [DOI] [PubMed] [Google Scholar]
  3. BJERKEDAL T. Overweight and hypertension. Acta Med Scand. 1957 Oct 30;159(1):13–26. doi: 10.1111/j.0954-6820.1957.tb00530.x. [DOI] [PubMed] [Google Scholar]
  4. Ballantyne D., Devine B. L., Fife R. Interrelation of age, obesity, cigarette smoking, and blood pressure in hypertensive patients. Br Med J. 1978 Apr 8;1(6117):880–881. doi: 10.1136/bmj.1.6117.880. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Behavioral methods in the treatment of hypertension. A review of their clinical status. Ann Intern Med. 1977 May;86(5):626–636. doi: 10.7326/0003-4819-86-5-626. [DOI] [PubMed] [Google Scholar]
  6. Benedict F. G., Roth P. Effects of a Prolonged Reduction in Diet on 25 Men: I. Influence on Basal Metabolism and Nitrogen Excretion. Proc Natl Acad Sci U S A. 1918 Jun;4(6):149–152. doi: 10.1073/pnas.4.6.149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Black H. R. Nonpharmacologic therapy for hypertension. Am J Med. 1979 May;66(5):837–842. doi: 10.1016/0002-9343(79)91125-2. [DOI] [PubMed] [Google Scholar]
  8. Boyle E., Jr Biological pattern in hypertension by race, sex, body weight, and skin color. JAMA. 1970 Sep 7;213(10):1637–1643. [PubMed] [Google Scholar]
  9. Brennan P. J., Simpson J. M., Blacket R. B., McGilchrist C. A. The effects of body weight on serum cholesterol, serum triglycerides, serum urate and systolic blood pressure. Aust N Z J Med. 1980 Feb;10(1):15–20. doi: 10.1111/j.1445-5994.1980.tb03412.x. [DOI] [PubMed] [Google Scholar]
  10. Chiang B. N., Perlman L. V., Epstein F. H. Overweight and hypertension. A review. Circulation. 1969 Mar;39(3):403–421. doi: 10.1161/01.cir.39.3.403. [DOI] [PubMed] [Google Scholar]
  11. Christian J. J. The potential role of the adrenal cortex as affected by social rank and population density on experimental epidemics. Am J Epidemiol. 1968 Mar;87(2):255–264. doi: 10.1093/oxfordjournals.aje.a120814. [DOI] [PubMed] [Google Scholar]
  12. DAHL L. K., SILVER L., CHRISTIE R. W. The role of salt in the fall of blood pressure accompanying reduction in obesity. N Engl J Med. 1958 Jun 12;258(24):1186–1192. doi: 10.1056/NEJM195806122582402. [DOI] [PubMed] [Google Scholar]
  13. DOYLE A. E., LOVELL R. R. Blood pressure and body build in men in tropical and temperate Australia. Clin Sci. 1961 Apr;20:243–247. [PubMed] [Google Scholar]
  14. EPSTEIN F. H., FRANCIS T., Jr, HAYNER N. S., JOHNSON B. C., KJELSBERG M. O., NAPIER J. A., OSTRANDER L. D., Jr, PAYNE M. W., DODGE H. J. PREVALENCE OF CHRONIC DISEASES AND DISTRIBUTION OF SELECTED PHYSIOLOGIC VARIABLES IN A TOTAL COMMUNITY, TECUMSEH, MICHIGAN. Am J Epidemiol. 1965 May;81:307–322. doi: 10.1093/oxfordjournals.aje.a120517. [DOI] [PubMed] [Google Scholar]
  15. Evaluation of drug treatment in mild hypertension: VA-NHLBI feasibility trial. Plan and preliminary results of a two-year feasibility trial for a multicenter intervention study to evaluate the benefits versus the disadvantages of treating mild hypertension. Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension. Ann N Y Acad Sci. 1978 Mar 30;304:267–292. doi: 10.1111/j.1749-6632.1978.tb25604.x. [DOI] [PubMed] [Google Scholar]
  16. FLETCHER A. P. The effect of weight reduction upon the blood-pressure of obese hypertensive women. Q J Med. 1954 Jul;23(91):331–345. [PubMed] [Google Scholar]
  17. Florey C. du V. The use and interpretation of ponderal index and other weight-height ratios in epidemiological studies. J Chronic Dis. 1970 Aug;23(2):93–103. doi: 10.1016/0021-9681(70)90068-8. [DOI] [PubMed] [Google Scholar]
  18. Frumkin K., Nathan R. J., Prout M. F., Cohen M. C. Nonpharmacologic control of essential hypertension in man: a critical review of the experimental literature. Psychosom Med. 1978 Jun;40(4):294–320. doi: 10.1097/00006842-197806000-00003. [DOI] [PubMed] [Google Scholar]
  19. Genuth S. M., Castro J. H., Vertes V. Weight reduction in obesity by outpatient semistarvation. JAMA. 1974 Nov 18;230(7):987–991. [PubMed] [Google Scholar]
  20. Gordon T., Kannel W. B. Predisposition to atherosclerosis in the head, heart, and legs. The Framingham study. JAMA. 1972 Aug 14;221(7):661–666. [PubMed] [Google Scholar]
  21. HUNTER J. D. Diet, body build, blood pressure, and serum cholesterol levels in coconut-eating Polynesians. Fed Proc. 1962 Jul-Aug;21(4):36–43. [PubMed] [Google Scholar]
  22. Heller R. F., Rose G., Pedoe H. D., Christie D. G. Blood pressure measurement in the United Kingdom Heart Disease Prevention Project. J Epidemiol Community Health. 1978 Dec;32(4):235–238. doi: 10.1136/jech.32.4.235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hsu P. H., Mathewson F. A., Rabkin S. W. Blood pressure and body mass index patterns-a longitudinal study. J Chronic Dis. 1977 Feb;30(2):93–113. doi: 10.1016/0021-9681(77)90078-9. [DOI] [PubMed] [Google Scholar]
  24. Johnson B. C., Karunas T. M., Epstein F. H. Longitudinal change in blood pressure in individuals, families and social groups. Clin Sci Mol Med Suppl. 1973 Aug;45 (Suppl 1):35s–345. doi: 10.1042/cs045035s. [DOI] [PubMed] [Google Scholar]
  25. Jung R. T., Shetty P. S., Barrand M., Callingham B. A., James W. P. Role of catecholamines in hypotensive response to dieting. Br Med J. 1979 Jan 6;1(6155):12–13. doi: 10.1136/bmj.1.6155.12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Kannel W. B., Brand N., Skinner J. J., Jr, Dawber T. R., McNamara P. M. The relation of adiposity to blood pressure and development of hypertension. The Framingham study. Ann Intern Med. 1967 Jul;67(1):48–59. doi: 10.7326/0003-4819-67-1-48. [DOI] [PubMed] [Google Scholar]
  27. Kazdin A. E. Artifact, bias, and complexity of assessment: the ABCs of reliability. J Appl Behav Anal. 1977 Spring;10(1):141–150. doi: 10.1901/jaba.1977.10-141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kelly M. B. A review of the observational data-collection and reliability procedures reported in The Journal of Applied Behavior Analysis. J Appl Behav Anal. 1977 Spring;10(1):97–101. doi: 10.1901/jaba.1977.10-97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Knittle J. L., Ginsberg-Fellner F., Brown R. E. Adipose tissue development in man. Am J Clin Nutr. 1977 May;30(5):762–766. doi: 10.1093/ajcn/30.5.762. [DOI] [PubMed] [Google Scholar]
  30. Kolata G. B. Obesity a growing problem. Science. 1977 Dec 2;198(4320):905–906. doi: 10.1126/science.198.4320.905. [DOI] [PubMed] [Google Scholar]
  31. Laughlin K. D., Fisher L., Sherrard D. J. Blood pressure reductions during self-recording of home blood pressure. Am Heart J. 1979 Nov;98(5):629–634. doi: 10.1016/0002-8703(79)90289-8. [DOI] [PubMed] [Google Scholar]
  32. MARKS H. H. Influence of obesity on morbidity and mortality. Bull N Y Acad Med. 1960 May;36:296–312. [PMC free article] [PubMed] [Google Scholar]
  33. MARTIN L. Effect of weight-reduction on normal and raised blood-pressures in obesity. Lancet. 1952 Nov 29;2(6744):1051–1053. doi: 10.1016/s0140-6736(52)91134-3. [DOI] [PubMed] [Google Scholar]
  34. MASTER A. M., JAFFE H. L., CHESKY K. Relationship of obesity to coronary disease and hypertension. J Am Med Assoc. 1953 Dec 26;153(17):1499–1501. doi: 10.1001/jama.1953.02940340001001. [DOI] [PubMed] [Google Scholar]
  35. Miall W. E., Bell R. A., Lovell H. G. Relation between change in blood pressure and weight. Br J Prev Soc Med. 1968 Apr;22(2):73–80. doi: 10.1136/jech.22.2.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Noppa H., Bengtsson C., Björntorp P., Smith U., Tibblin E. Overweight in women--metabolic aspects. The population study of women in Göteborg 1968--1969. Acta Med Scand. 1978;203(1-2):135–141. [PubMed] [Google Scholar]
  37. Noppa H. Body weight change in relation to incidence of ischemic heart disease and change in risk factors for ischemic heart disease. Am J Epidemiol. 1980 Jun;111(6):693–704. doi: 10.1093/oxfordjournals.aje.a112947. [DOI] [PubMed] [Google Scholar]
  38. PADMAVATI S., GUPTA S. Blood pressure studies in rural and urban groups in Delhi. Circulation. 1959 Mar;19(3):395–405. doi: 10.1161/01.cir.19.3.395. [DOI] [PubMed] [Google Scholar]
  39. PALMAI G. Skin-fold thickness in relation to body weight and arterial blood pressure. Med J Aust. 1962 Jul 7;49(2):13–15. [PubMed] [Google Scholar]
  40. Rabkin S. W., Mathewson F. A., Hsu P. H. Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study. Am J Cardiol. 1977 Mar;39(3):452–458. doi: 10.1016/s0002-9149(77)80104-5. [DOI] [PubMed] [Google Scholar]
  41. Ramsay L. E., Ramsay M. H., Hettiarachchi J., Davies D. L., Winchester J. Weight reduction in a blood pressure clinic. Br Med J. 1978 Jul 22;2(6132):244–245. doi: 10.1136/bmj.2.6132.244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Reisin E., Abel R., Modan M., Silverberg D. S., Eliahou H. E., Modan B. Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. N Engl J Med. 1978 Jan 5;298(1):1–6. doi: 10.1056/NEJM197801052980101. [DOI] [PubMed] [Google Scholar]
  43. SALZANO J. V., GUNNING R. V., MASTOPAULO T. N., TUTTLE W. W. Effect of weight loss on blood pressure. J Am Diet Assoc. 1958 Dec;34(12):1309–1312. [PubMed] [Google Scholar]
  44. SELTZER C. C., MAYER J. A SIMPLE CRITERION OF OBESITY. Postgrad Med. 1965 Aug;38:A101–A107. doi: 10.1080/00325481.1965.11695628. [DOI] [PubMed] [Google Scholar]
  45. Seltzer C. C., Stoudt H. W., Jr, Bell B., Mayer J. Reliability of relative body weight as a criterion of obesity. Am J Epidemiol. 1970 Dec;92(6):339–350. doi: 10.1093/oxfordjournals.aje.a121216. [DOI] [PubMed] [Google Scholar]
  46. Sive P. H., Medalie J. H., Kahn H. A., Neufeld H. N., Riss E. Correlation of weight-height index with diastolic and with systolic blood pressure. Br J Prev Soc Med. 1970 Nov;24(4):201–204. doi: 10.1136/jech.24.4.201. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Souchek J., Stamler J., Dyer A. R., Paul O., Lepper M. H. The value of two or three versus a single reading of blood pressure at a first visit. J Chronic Dis. 1979;32(3):197–210. doi: 10.1016/0021-9681(79)90065-1. [DOI] [PubMed] [Google Scholar]
  48. Stamler J., Farinaro E., Mojonnier L. M., Hall Y., Moss D., Stamler R. Prevention and control of hypertension by nutritional-hygienic means. Long-term experience of the Chicago Coronary Prevention Evaluation Program. JAMA. 1980 May 9;243(18):1819–1823. [PubMed] [Google Scholar]
  49. Stamler R., Stamler J., Riedlinger W. F., Algera G., Roberts R. H. Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA. 1978 Oct 6;240(15):1607–1610. doi: 10.1001/jama.240.15.1607. [DOI] [PubMed] [Google Scholar]
  50. Surwit R. S., Hager J. L., Feldman T. The role of feedback in voluntary control of blood pressure in instructed subjects. J Appl Behav Anal. 1977 Winter;10(4):625–631. doi: 10.1901/jaba.1977.10-625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. THOMAS C. B., COHEN B. H. The familial occurrence of hypertension and coronary artery disease, with observations concerning obesity and diabetes. Ann Intern Med. 1955 Jan;42(1):90–127. doi: 10.7326/0003-4819-42-1-90. [DOI] [PubMed] [Google Scholar]
  52. Taylor C. B., Farquhar J. W., Nelson E., Agras S. Relaxation therapy and high blood pressure. Arch Gen Psychiatry. 1977 Mar;34(3):339–342. doi: 10.1001/archpsyc.1977.01770150097011. [DOI] [PubMed] [Google Scholar]
  53. Tobian L., Jr Dietary salt (sodium) and hypertension. Am J Clin Nutr. 1979 Dec;32(12 Suppl):2659–2663. doi: 10.1093/ajcn/32.12.2659. [DOI] [PubMed] [Google Scholar]
  54. Tobian L. The relationship of salt to hypertension. Am J Clin Nutr. 1979 Dec;32(12 Suppl):2739–2748. doi: 10.1093/ajcn/32.12.2739. [DOI] [PubMed] [Google Scholar]
  55. WHYTE H. M. BEHIND THE ADIPOSE CURTAIN. STUDIES IN AUSTRALIA AND NEW GUINEA RELATING TO OBESITY AND CORONARY HEART DISEASE. Am J Cardiol. 1965 Jan;15:66–80. doi: 10.1016/0002-9149(65)90605-3. [DOI] [PubMed] [Google Scholar]
  56. WHYTE H. M. Blood pressure and obesity. Circulation. 1959 Apr;19(4):511–516. doi: 10.1161/01.cir.19.4.511. [DOI] [PubMed] [Google Scholar]
  57. Weinsier R. L., Fuchs R. J., Kay T. D., Triebwasser J. H., Lancaster M. C. Body fat: its relationship to coronary heart disease, blood pressure, lipids and other risk factors measured in a large male population. Am J Med. 1976 Dec;61(6):815–824. doi: 10.1016/0002-9343(76)90405-8. [DOI] [PubMed] [Google Scholar]
  58. Wilcox R. G. Serum lipid concentrations and blood pressure in obese women. Br Med J. 1978 Jun 10;1(6126):1513–1515. doi: 10.1136/bmj.1.6126.1513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Womersley J. A comparison of the skinfold method with extent of 'overweight' and various weight-height relationships in the assessment of obesity. Br J Nutr. 1977 Sep;38(2):271–284. doi: 10.1079/bjn19770088. [DOI] [PubMed] [Google Scholar]
  60. Wooley S. C., Wooley O. W., Dyrenforth S. R. Theoretical, practical, and social issues in behavioral treatments of obesity. J Appl Behav Anal. 1979 Spring;12(1):3–25. doi: 10.1901/jaba.1979.12-3. [DOI] [PMC free article] [PubMed] [Google Scholar]

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