Effect of moderate weight reduction on resting and exercise blood pressure in overweight subjects

Abstract

The effect of weight reduction by dietary restriction on exercise blood pressure (BP) was studied in ten volunteers with a body mass index (BMI) 425 kg/ m. By weight reduction (on average 11.5%), resting systolic/diastolic BP decreased from 137715/ 84710 to 124711/7779 mm Hg (Po0.001 for systolic and Po0.01 for diastolic BP), and peak exercise systolic/diastolic BP decreased from 221722/86713 to 200724/79721 mm Hg (Po0.01 for systolic and P1⁄4 0.08 for diastolic BP). A moderate weight reduction lowers BP at rest and during exercise testing by approximately 8–10%. Overweight is amongst the strongest risk factors for hypertension. Previous studies proved that weight reduction lowers resting BP. In contrast, only one previous study assessed the effect of weight reduction on exercise BP and found a decrease. The generalizability of that study is limited as participants were morbidly obese and weight reduction was achieved by surgical gastric restriction. However, exercise BP is of interest as systolic exercise BP was shown to predict end organ damage and cardiovascular mortality. Results from resting BP cannot be generalized to exercise BP since physiological mechanisms of the two entities are dissimilar. We, therefore, assessed the effect of a moderate weight reduction using dietary restriction on lowering exercise BP in a group of overweight volunteers. Volunteers with a BMI 425 kg/m were invited to participate in the study. Of 17 eligible volunteers, six had to be excluded as one or more predefined exclusion criteria were met. These criteria comprised lacking volition to reduce weight, severe hypertension (systolic BPX160 or diastolic BPX100 mm Hg), history of cardiovascular or pulmonary disease, intake of drugs and pregnancy. The local Ethical Committee approved the protocol and each subject gave written informed consent. The baseline examination (before weight reduction) was performed by the evaluation personnel (physician and nurses). It comprised a resting ECG, BP measurements at rest, a 24 h ambulatory BP monitoring (ABPM), and an exercise test. Resting BP and ABPM were measured with automated systems using the oscillometric method (Spot Vital Signs, Welch Allyn, Skaneateles Falls, USA; BR-102 plus, Schiller AG, Baar, Switzerland). Exercise BP was measured with a fully automated system (Cardiovit CS-200, Schiller AG, Baar, Switzerland). The workload was increased according to a defined ramp protocol by 20 W/min to the maximal tolerated level. BP was measured once per exercise intensity with a standardized timing. Physical activity during 2 subsequent days was assessed by pedometer (Bodywatch, Kasper&Richter, Uttenreuth, Germany). After the baseline examination, all participants received dietary counselling by the intervention personnel (physician and dieticians). The counselling comprised a protein sparing modified fasting (ketogenic diet). The ketogenic diet prescribes food high in fat and restricts carbohydrate intake. The participants were instructed to continue their exercise habits. No attempt was made to change their smoking or drinking habits during the diet. All participants were contacted by phone every 8 to 12 weeks to assess weight loss and to invite them for further dietary counselling if necessary. The followup examination was scheduled as soon as the reported weight reduction exceeded 5% of the baseline body weight. The followup examination was identical to the baseline examination and was performed by the evaluation personnel. Results are expressed as mean7s.d. Mean arterial BP was defined as diastolic BP plus one-third of the difference between systolic and diastolic BP. Paired t-test was used for comparisons between BP levels after checking for normal distribution. Values of Po0.05 were considered to indicate statistical significance. Ten of 11 recruited subjects lost at least 5% of their initial weight. One subject was excluded from the analysis because he failed to lose weight and lost his volition to continue (weight at enrolment was 91 and 90 kg at last followup). The mean age of the remaining 10 study participants was 36.679.7 years (range 24–50 years): two were women and eight were male. Five participants were current smokers. The median time between examination before and after weight reduction was 20 weeks (25th and 75th percentiles: 16 and 30 weeks). BMI was 31.973.7 kg/m (range 28.7–40.2 kg/m) before and 28.273.1 kg/m (range 25.0–34.1 kg/m) after weight reduction (Po0.001). Weight was reduced by 11.573.4% (range 6–17%). Physical activity Journal of Human Hypertension (2007) 21, 683–685 & 2007 Nature Publishing Group All rights reserved 0950-9240/07 $30.00

DOI: 10.1038/sj.jhh.1002204

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@article{Schnenberger2007EffectOM, title={Effect of moderate weight reduction on resting and exercise blood pressure in overweight subjects}, author={Astrid Sch{\"{o}nenberger and Renate Schoenenberger-Berzins and P. M. Suter and Michel Zuber and P. Erne}, journal={Journal of Human Hypertension}, year={2007}, volume={21}, pages={683-685} }