Top Things to Know: Weight-Loss Strategies for Prevention and Treatment of Hypertension

Published: September 20, 2021

  1. Recently published estimates revealed that nearly half (45%) of adults in the United States (US) have hypertension (HTN) defined as systolic blood pressure BP (SBP) ≥130mmHg, diastolic BP (DBP) ≥80mmHg, or are taking anti-hypertensive medications.
  2. Based on recent estimates from the World Health Organization, more than 1.0 billion adults were overweight and over 650 million of them were obese. The prevalence of severe obesity among US adults was 9.2% from 2017-2018, a 38% increase from just 10 years earlier.
  3. HTN is a major contributor of increased mortality, chronic kidney disease (CKD), and cardiovascular disease (CVD) including myocardial infarction, heart failure (HF) and stroke. Intentional weight-loss strategies represent ideal targets to reduce risk for chronic diseases and mortality in individuals with overweight, or obesity who are hypertensive.
  4. This scientific statement discusses the pathophysiology of obesity-hypertension, mechanisms that initiate obesity-associated hypertension, sympathetic nervous system activation, renal angiotensin-aldosterone system activation, kidney compression, inflammation, metabolic disorders and progressive cardiorenal injury that exacerbate obesity-associated HTN.
  5. Lifestyle modification including diet, reduced sedentary behavior, and increased physical activity are usually recommended for patients with obesity; but the long-term success of these strategies for reducing adiposity, maintaining weight-loss, and reducing blood pressure has been limited.
  6. The impact of the Mediterranean, DASH, and intermittent fasting diets on sustained weight-loss in hypertension patients are reviewed in this statement.
  7. Medications can be useful for short and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery (MS) is effective for producing sustained weight-loss and for treating HTN and metabolic disorders in severely obese patients.
  8. Pharmacotherapy, using drugs approved by the Food and Drug Administration for weight-loss can be considered for weight management in patients who have limited treatment response to lifestyle modifications and have a BMI > 30 kg/m2, or a BMI > 27kg/m2 in the presence of weight-related comorbidities such as HTN. Anti-obesity pharmacotherapy is intended for use as an adjunct to diet and exercise.
  9. A total of 216,000 metabolic surgeries (MSs) were performed in the US in 2016. Sleeve gastrectomy is the most common, followed by Roux-en-Y gastric bypass, adjustable gastric band, and biliopancreatic diversion with duodenal switch, in order of use. The indications of these surgical types and randomized clinical trials (RCTs) for MSs as an intervention, are discussed in this statement.
  10. Lifestyle modifications of diet changes and physical activity are gold-standards for reducing weight and consequently high blood pressure (BP), but may be difficult for many patients to maintain. Evidence-based treatments such as pharmacotherapy and MS can be utilized to effectively treat obesity, and as a result, lower BP. RCTs are needed to study the longer-term risk reduction for obesity-related diseases such as CKD, stroke, and HF.


Hall ME, Cohen JB, Ard JD, Egan BM, Hall JE, Lavie CJ, Ma J, Ndumele CE, Schauer PR, Shimbo D; on behalf of the American Heart Association Council on Hypertension; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; and Stroke Council. Weight loss strategies for prevention and treatment of hypertension: a scientific statement from the American Heart Association [published online ahead of print September 20, 2021]. Hypertension. doi: 10.1161/HYP.0000000000000202