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March 24, 2008

Long-term Effects of Weight-Reducing Interventions in Hypertensive Patients: Systematic Review and Meta-analysis

Author Affiliations

Author Affiliations: EBM Review Center, Department of Internal Medicine, Medical University of Graz, Graz, Austria (Drs Horvath, Jeitler, Gratzer, and Siebenhofer); German Institute for Quality and Efficiency in Health Care, Cologne, Germany (Drs Siering, Stich, and Skipka); and Deutsche Krebshilfe-German Cancer Aid, Bonn, Germany (Dr Siering).

Arch Intern Med. 2008;168(6):571-580. doi:10.1001/archinte.168.6.571

Weight loss is recommended in all major guidelines for antihypertensive therapy. We searched for randomized controlled trials investigating the effects of weight-reducing diets, pharmacologic substances, and invasive interventions for weight reduction on patient-relevant end points and blood pressure (BP) in patients with essential hypertension. No information on the effects on patient-relevant end points was available. Patients assigned to weight loss diets, orlistat, or sibutramine reduced their body weight more effectively than did patients in the usual care/placebo groups. Reduction of BP was higher in patients treated with weight loss diets (systolic BP [SBP]: weighted mean difference [WMD], −6.3 mm Hg; diastolic BP [DBP]: WMD, −3.4 mm Hg) or orlistat (SBP: WMD, −2.5 mm Hg; DBP: WMD, −2.0 mm Hg). Systolic BP increased with sibutramine treatment (WMD, 3.2 mm Hg). In patients with essential hypertension, therapy with a weight loss diet or orlistat resulted in reductions in body weight and BP. Although sibutramine treatment reduced body weight, it did not lower BP.