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August 9, 1993

Reduction in Long-term Antihypertensive Medication Requirements: Effects of Weight Reduction by Dietary Intervention in Overweight Persons With Mild Hypertension

Author Affiliations

From the Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston (Dr Davis, Mr Zimbaldi); Departments of Nuclear Medicine (Dr Blaufox), Epidemiology—Social Medicine (Dr Wassertheil-Smoller), Albert Einstein College of Medicine, Bronx, NY; Division of General— Preventive Medicine, University of Alabama, Birmingham (Dr Oberman); Division of Epidemiology— Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Cutler); Department of Medicine, University of Mississippi Medical Center, Jackson (Drs Kirchner and Langford).

Arch Intern Med. 1993;153(15):1773-1782. doi:10.1001/archinte.1993.00410150051005

Background:  Increasing concern over long-term drug treatment of mild hypertension has stimulated several studies of weight reduction. Phase I of the Trial of Antihypertensive Interventions and Management demonstrated a short-term effect of weight loss on blood pressure control in overweight persons with mild hypertension, who were either taking placebo or taking low-dose monotherapy. Phase II investigates the long-term benefit of weight loss on the ability to maintain blood pressure control.

Methods:  From 10 148 community-based screenees, 587 persons (5.8%), aged 21 to 65 years, entered a multicenter, randomized drug (double-blind, placebocontrolled) and diet trial. Participants had a diastolic blood pressure between 90 and 100 mm Hg and were at 110% to 160% of their ideal weight. They were randomized to a usual diet (n=296) or to a weight loss diet (n=291) and within each diet group to placebo, chlorthalidone, 25 mg/d, or atenolol, 50 mg/d. Treatment failure was defined as using additional antihypertensive medications if diastolic blood pressure rose above 90 mm Hg according to protocol-specified criteria.

Results:  At baseline, mean diastolic blood pressure was 93 mm Hg; systolic blood pressure, 143 mm Hg; weight, 88 kg; percent ideal weight, 137%; age, 48 years; 56% were men; and 33% were black. Mean follow-up was 4.5 years. There was a net loss of 2 to 3 kg with weight loss diet compared with usual diet over most of the follow-up period. The 5-year incidence of treatment failure was 56.7 per 100 participants with usual diet and 49.8 per 100 with weight loss. Long-term weight loss decreased failure of blood pressure control for those receiving placebo or low-dose diuretic or β-blocker by 23%. The results were similar in direction in each drug group.

Conclusions:  The Trial of Antihypertensive Interventions and Management demonstrated that weight reduction is an effective long-term therapy for maintaining blood pressure in the normal range when used as monotherapy or in combination with either thiazide diuretics or β-blockers. Consequently, weight loss should be recommended for the management of obese individuals with mild hypertension.(Arch Intern Med. 1993;153:1773-1782)