According to the CDC, nearly half of all adults in the United States have high blood pressure, also known as hypertension. There are many factors that increase the risk of developing hypertension, including excess body weight. As a result, losing weight is often one of the recommendations for the treatment of high blood pressure. But what are the effects of excess weight loss on blood pressure? And how much do you have to lose to see reductions in blood pressure?

What is hypertension?

First, let's review hypertension in more detail. Hypertension is diagnosed when your blood pressure level is consistently higher than normal. Blood pressure refers to the intensity at which your blood pushes against the walls of your arterial blood vessels. High blood pressure is a problem because over time it increases the risk of more serious problems like cardiovascular diseases or stroke.

When we measure blood pressure, we get two numbers:

Systolic blood pressure is the pressure in your arteries when your heart beats. It is the top number in a blood pressure reading.

Diastolic blood pressure is the pressure in your arteries when your heart relaxes in between beats. It is recorded as the bottom number in a blood pressure reading.

Your blood pressure level is reported as the systolic pressure over the diastolic pressure. The most recent guidelines from the American College of Cardiology and the American Heart Association say that a diagnosis of hypertension should be made when your systolic blood pressure is 130 mmHg or greater OR your diastolic blood pressure is 80 mmHg or greater (based on an average of ≥ 2 careful readings obtained on ≥ 2 separate occasions). 

What causes hypertension?

There are two types of hypertension – primary and secondary. Primary hypertension, also known as essential hypertension, is the most common type of hypertension. The cause of primary hypertension is likely a combination of genetics and environmental factors. Secondary hypertension is less common and the result of a medical condition or medication.

There are a number of risk factors for the development of essential hypertension. Some of them are within our control and modifiable while others are not. Modifiable risk factors include a high-salt diet, physical inactivity, excess body weight (especially in the midsection), tobacco use, and alcohol use. Non-modifiable risk factors that increase hypertension risk include family history/genetics, age, male gender, and race.

Many chronic diseases also increase the risk of hypertension. These include obstructive sleep apnea, high cholesterol, diabetes mellitus, and chronic kidney disease. While these may be out of our control, they can often be improved with healthy eating habits, regular physical activity, and weight loss.

How are obesity and hypertension related?

Excess body weight is considered a major risk factor for the development of hypertension with many studies showing a link between weight gain and increasing blood pressure. One study in particular found that compared to normal weight individuals, those living overweight or with obesity were 1.5x more likely to develop hypertension. The reasons for this are complex and still being investigated, and likely involve a combination of the following mechanisms:

• Excess body weight increases the activity of the central nervous system through elevated insulin and leptin levels. Increasing activity of the central nervous system increases blood pressure.
• Excess body weight increases sodium reabsorption in the kidneys. This increases blood volume and the pressure on the walls of the arteries.
• Excess body weight is associated with inflammation and abnormal function of the arteries. This leads to hardening and narrowing of the arteries, which in turn increases arterial pressure.

The good news is that science supports that losing weight or maintaining a healthy body weight can be effective for blood pressure management. Weight loss is often the first treatment recommendation when high blood pressure is diagnosed, and can also prevent the the worsening of your condition over time.

Treatments for high blood pressure

The goal of hypertension treatment is to reduce blood pressure in order to reduce the risk of serious conditions like heart attack and stroke. There are a number of things you can do to combat this condition including:

• Eat a heart-healthy diet with less salt– Research shows that a diet rich in fruits, vegetables, whole grains, and lean protein with less saturated fat can reduce blood pressure and the risk for heart disease. Additionally, reducing salt intake by at least 1000 mg per day (ideally consuming 1500 mg or less in a day) can contribute to lowering hypertension.

• Participate in regular physical activity– Regular exercise helps with weight management and lowering blood pressure, independent of weight loss.

• Lose weight if you have excess body weight– Long term weight loss is one of the best things you can do to control hypertension. You can expect to lower your blood pressure by about 1 point for each 2.2 pounds of weight you lose.

• Limit alcohol consumption– Men should aim to consume no more than 2 standard drinks per day and women no more than 1 standard drink per day. A standard drink is 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits. Limiting alcohol consumption is also helpful in weight management, it can also lead to reductions in blood pressure in this way.

• Quit smoking– If you smoke or use tobacco products, quitting can be one of the most important things you can do for your health. This is in part due to the reduction in blood pressure that occurs with quitting smoking.

• Medications– If your blood pressure levels are significantly elevated, you are at high risk for heart disease, or your blood pressure does not improve with a trial of healthier habits and weight loss, your healthcare provider may recommend starting a blood pressure medication. Some classes of medications used to treat hypertension include: Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARBs),Calcium channel blockers, Diuretics, and Beta blockers.

Lower blood pressure with weight loss & lifestyle changes

The combination of lifestyle intervention and weight loss can have a big impact on lowering your blood pressure, ultimately reducing the number of medications you take and the risk of serious conditions like heart attack and stroke. While there is no best diet for weight loss, there have been studies to suggest that eating a diet high in fruits, vegetables, whole grains, and lean protein and low in saturated fat, salt, and alcohol work well for both weight loss and blood pressure reduction. One such diet with a lot of scientific evidence behind it is the Dietary Approaches to Stop Hypertension (DASH) diet. But any healthy eating plan that reduces calories can be an effective approach. And doing this in combination with physical activity can have even greater benefits. There is no specific exercise prescription to follow here as both aerobic and resistance training and high and low intensity exercise have all been shown to provide benefits for weight loss and blood pressure. The goal is to just get moving more, whatever that means for you.

Making these healthful lifestyle changes can lower your blood pressure and reduce your risk of heart disease independent of weight loss. However, when you also achieve weight loss, the benefits are even greater. And it doesn't have to be much – studies show that losing even 5% of your body weight can have a significant impact.

If you are making appropriate changes to your diet and physical activity level, but not achieving weight loss, it may be time to consider seeking help from a healthcare professional. They can help you to develop an individualized heart-healthy treatment plan using evidence-based approaches including nutrition modifications, guidance on increasing physical activity, assistance with long-term behavior change, and the use of FDA-approved weight loss medication when appropriate.

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