Obesity and Hypertension: What Should We Do?

• Obesity
• Hypertension
• Antihypertensive agents
• Weight loss
• Behavior therapy

The treatment of hypertension represents a major international problem. It is estimated that only 27% of hypertensive persons in the United States have their blood pressure controlled, which is a smaller proportion than 10 years ago (1). Over the same period, expenditures on antihypertensive drugs have nearly doubled (2), and even when blood pressure is adequately controlled by medication, hypertensive patients are still at substantially higher risk for cardiovascular morbidity than normotensive persons (3). Although blood pressure tends to increase with age, this process is not inevitable, and one of its major modifiable risk factors is body weight. In the United States, obesity is now a major epidemic (4). Hypertension is just one of its numerous adverse consequences, and it has been shown that a person's medical care costs are directly proportional to his or her body mass index (5).

Phase II of the Trials of Hypertension Prevention (TOHP II) was designed to investigate the effects of weight loss and sodium restriction, alone and in combination, on blood pressure in people with borderline elevations (6). The main finding, published in 1997, was that weight loss produced slightly greater reductions in blood pressure than did sodium restriction, but the average changes in weight and blood pressure were small.

In a subsequent analysis of TOHP II in this issue, Stevens and colleagues (7) looked more closely at the weight loss group, paying particular attention to the dose–response relationship between weight loss and blood pressure. A common feature of many studies of the effects of lifestyle and dietary changes on blood pressure is that changes …