Obesity decreases concentration

Obesity and Hypertension: What's the Point in Losing Weight?

Doctors have long known that obesity is harmful: "Already in Islam 1000 years ago it was assigned a high disease value," recalled Professor Gerd Bönner from the Lazariterhof Clinic in Bad Krozingen in Berlin. Today, abdominal obesity is particularly important.

In the new guidelines of the Hypertension League, it is now expressly listed as a risk factor when determining the cardiovascular risk: waist circumference in men from 102 centimeters and in women from 88 centimeters. Because this heart attack risk factor is in no way inferior to the risk factors hypertension, diabetes and smoking.

Obesity and hypertension often coexist

This is confirmed by new data, such as that of the Interheart study with 27,000 patients. There was only a vague relationship between myocardial infarction rate and BMI (body mass index), but a linear relationship between waist size and heart attack risk. The heart attack risk correlated best with the waist-hip ratio. This correlation exists in all BMI categories - even with a BMI below 20 kg / m2.

People with obesity often have hypertension. And obese people are at increased risk of developing hypertension. Losing weight can prevent it - but only if it is clear and lasting.

In overweight hypertensive patients, weight reduction can significantly lower blood pressure. A weight loss of 10 kg reduces the systolic blood pressure by 15 mmHg, the distolic blood pressure by 8 to 10 mmHg. Much less is probably more realistic for many patients. If you lose 5 kg, the blood pressure drops as well as with monotherapy with a diuretic, says Bönner.

In studies, blood pressure reductions of up to 6 mmHg systolic or 3 mmHg diastolic were achieved, emphasizes Bönner. The blood pressure decreases with weight loss only in hypertensive patients. "Hardly any effect is achieved in patients with normal blood pressure - only about 0.3 mmHg per kilo," said Bönner.

How fast you lose weight doesn't seem to matter. In one study, the participants lost weight in three groups: with placebo, with pharmacological support at a normal pace, and with pharmacological support particularly quickly. The blood pressure reacted the same in all groups in the first month. "The main reduction occurs in the first four weeks. This phenomenon can be found again and again in studies," says Bönner.

This may be due to the weight loss alone. Or the patients automatically consume less salt because they eat less. Or the shortening of food and weight loss trigger a strong effect at the beginning, which then flattens off again.

Salt sensitivity decreases with weight loss

There is another effect on obese people: they are sensitive to salt, says Bönner. When they consume table salt, their blood pressure rises. When patients lose weight, salt sensitivity decreases again. In addition: Obese people have an increased concentration of norepinephrine, which increases blood pressure. If the patients lose weight, the norepinephrine level falls again.

It is not known why the blood pressure rises again after a while after continuous weight loss. One example of this is the Swedish SOS study (Swedish Obese Subjects) with 4000 obese patients (BMI:> 40 kg / m2). The patients received gastric banding or gastric bypass.

After two years, the systolic blood pressure had decreased by 6.3 and diastolic by 4.7 mmHg. Over the next eight years, however, it rose again by 7 mmHg systolic and diastolic by 2.4 mmHg, although the patients weighed 19 kg less than at the beginning. Perhaps this development is age-related. (hbr)