AHA Outlines Weight Loss Strategies for Preventing Obesity Hypertension

Michael Hall, MD

In response to the growing obesity epidemic, the American Heart Association (AHA) has released guidance in the form of a scientific statement outlining weight-loss strategies for the prevention and treatment of hypertension.

With data suggesting more than 100 million in the US have hypertension, the scientific statement outlines the need for effective, long-term solutions to weight loss to maintain reductions in hypertension and also calls for clinicians to consider other avenues outside of lifestyle modification for weight loss, such as medications and metabolic surgery.

“Weight loss achieved through dietary changes and increased physical activity are the cornerstones of treatment for high blood pressure that’s related to being overweight. However, these lifestyle behaviors are often not sustained over the long term. Subsequently, reductions in blood pressure aren’t maintained over time,” said Chair of the statement writing group Michael E. Hall, MD, MS, FAHA, associate division director for cardiovascular diseases at the University of Mississippi Medical Center in Jackson, Mississippi, in a statement from the AHA. “The new scientific statement suggests medical and surgical strategies may help with long-term weight and blood pressure improvement, in addition to a heart-healthy diet and physical activity.”

The AHA’s scientific statement, which is 13 pages in length and contains nearly 100 references, opens by providing clinicians with an overview of epidemiology and pathophysiology of obesity hypertension before diving into avenues for reducing body weight, including lifestyle modification, pharmacotherapy, and bariatric procedures. Underlining the AHA’s stance from their June 2021 statement, the present statement, which was prepared on behalf of the AHA’s Council on Hypertension, the Council on Arteriosclerosis, Thrombosis, and Vascular Biology, the Council on Lifestyle and Cardiometabolic Health, and the Stroke Council, outlines the importance of dietary interventions and physical activity as first-line treatment for weight loss and hypertension control, but investigators were quick to point out these changes can be difficult to maintain long-term and can lead to recurrent increases in hypertension.

“There’s no doubt that eating healthy foods has beneficial effects on both weight and blood pressure,” Hall explained. “Numerous weight-loss diets are often successful in the short term; however, eating healthy foods consistently and long term, and maintaining weight loss are challenging.”

The next portion of the statement called for an increase in consideration of pharmacologic therapies for obesity hypertension, if lifestyle modifications have proven unsuccessful in achieving weight reduction and blood pressure control. In addition to FDA approved therapies for long-term weight loss, authors highlight the latest revelations related to the potential for reductions in body weight and blood pressure seen with GLP-1 receptor agonists. Specifically, liraglutide and once-weekly semaglutide 2.4 mg, which was not yet approved at the time of writing, were highlighted by statement authors.

“We often don’t consider medications or metabolic surgery until after there has been target organ damage, such as heart injury or having a stroke. However, we may be able to prevent these complications. When combined with lifestyle changes, anti-obesity medicines and surgical procedures can be effective long-term solutions for weight loss and blood pressure control in select individuals who are overweight or have obesity,” Hall added.

The last treatment approach discussed within the statement highlighted surgery for weight loss. Although considered a newer approach to mitigating the effects of obesity, authors point out the popularity and safety of these procedures have grown in recent years. According to the statement, more than 215,000 metabolic procedures were performed in 2016, with the most popular being sleeve gastrectomy followed by Roux-en-Y gastric bypass. With these types of procedures typically reserved for candidates with a BMI at or equal to 35 kg/m2, investigators point out observational data suggests bariatric procedures could contribute tor solution of hypertension in 63% of procedures. Additionally, authors highlight the contributions of the GATEWAY trial, as it is the only controlled trial involved metabolic surgery with blood pressure as a primary end point, to our current understanding of the effects of metabolic surgery. In that trial, patients were 6 times more likely to experience resolution of hypertension with metabolic surgery than they were with standard medical therapy.

“Metabolic surgery techniques are continuing to evolve, and they are getting less invasive and less risky,” Hall said. “For select individuals, medications or metabolic surgery or both may be considered in addition to healthy diet and increased physical activity.”

Before the conclusion of their statement, authors highlighted what they perceive as areas in need of further research related to obesity hypertension. Specific research recommendations included the need for more randomized trials in the space, research into the mechanisms of obesity-related diseases, and the need for a greater understanding of the long-term safety and efficacy of various treatment and prevention strategies.

“There are still many unanswered questions and many opportunities for research that can help people live healthier, longer,” Hall added.

This scientific statement, “Weight-Loss Strategies for Prevention and Treatment of Hypertension,” was published in Hypertension.