Treatment of obesity-associated hypertension

Many obese people are hypertensive either because of obesity-associated hypertension or because the two conditions coexist. Weight loss is recommended for all obese hypertensives as some patients benefit by concomitant reductions of arterial pressure and/or decreased requirements for antihypertensive drugs. Since obesity-associated hypertension cannot be diagnosed as a separate entity, available evidence was reviewed to determine the antihypertensive effectiveness of weight loss and effects of weight loss on antihypertensive drug requirements. Generally speaking, patients with mild hypertension appear to respond better to weight reduction than those with moderate and severe hypertension. However, a substantial percentage of patients with mild hypertension may be unresponsive. Weight loss also seems to have potential for lessening requirements for antihypertensive drug therapy. Beneficial effects for both blood pressure and drug requirements are due to weight loss and not caloric restriction, per se. Mechanisms of the beneficial effects are related to consequences of weight loss and appear to involve decreased cardiac output and blood volume. The issue of salt sensitivity of obesity-associated hypertension is unresolved.