Weight-loss meds, surgery could fight obesity-related high blood pressure

Losing weight can be crucial to controlling blood pressure. But when diet and exercise fail to help, medications and surgery are appropriate treatments, according to a new expert analysis of weight-loss strategies.

High blood pressure, or hypertension, can lead to kidney problems, heart injury and stroke. But only a fraction of eligible patients are prescribed weight-loss medicine or referred for metabolic surgery, Dr. Michael E. Hall said in a news release. He led the expert panel that wrote the report from the American Heart Association.

Even though treatments might help prevent serious complications, he said, they often aren't considered until after someone has suffered organ damage.

"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 obese," said Hall, associate division director for cardiovascular diseases at the University of Mississippi Medical Center in Jackson.

The scientific statement was published Monday in the American Heart Association journal Hypertension. It follows previous statements on diet, physical activity and weight control.

Weight loss through a healthy diet and increased physical activity is the cornerstone of treatment for high blood pressure that's related to being overweight, Hall said.

National guidelines recommend a heart-healthy diet to help manage weight and control blood pressure. The Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) are well-established options, the report said. Both emphasize eating more fruits, vegetables, legumes, nuts and seeds; moderate amounts of fish, seafood, poultry and dairy; and low quantities of sweets and red and processed meats.

The statement also looked at intermittent fasting, an approach that alters the timing of eating and fasting during the day or week. It produced modest reductions in blood pressure in a few studies involving people with metabolic syndrome, a group of conditions that can lead to heart disease. However, analyses of several studies found intermittent fasting had a weak impact on blood pressure and was no more effective than other diets in reducing weight.

"There's no doubt that eating healthy foods has beneficial effects on both weight and blood pressure," Hall said. "Numerous weight-loss diets are often successful in the short term."

But maintaining weight loss in the long term is challenging, he said. So when diet and exercise aren't working, health professionals should consider prescription medications for people who have a weight-related health issue such as high blood pressure.

A class of medications called GLP-1 receptor agonists have been shown to help with sustained weight loss and significantly reducing blood pressure, according to the statement. GLP-1 agonists, such as liraglutide and semaglutide, are synthetic hormones self-injected daily or weekly that reduce appetite and help people feel full.

Both medications were initially prescribed to treat Type 2 diabetes because they lower blood sugar by stimulating the release of insulin. The Food and Drug Administration recently approved both for weight management and weight loss in people classified as overweight or obese.

Obesity is measured by body mass index, a ratio of weight to height. A person with a BMI of 25 to 29 is classified as being overweight. Someone with a BMI of 30 or greater is considered obese.

The statement includes a research review on metabolic surgery, also called bariatric surgery or gastric bypass surgery. It can aid weight loss in people with severe obesity, defined as people who have a BMI of 40 or higher, or if they have a BMI of 35 or higher along with an obesity-related health condition such as hypertension.

High blood pressure resolves in 63% of people who have metabolic surgery, the report said, and several studies show less use of blood pressure-lowering medicines after surgery.

"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."

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