Treat High Blood Pressure With Weight Loss

Weight Loss is one of the most effective non-pharmacological interventions for managing high blood pressure.

I've been working in primary care in various roles for well over a decade. Through all the good and bad, there's one moment that seems more crushing that almost all the rest -- (cancer and end of life discussions aside) -- and that is the moment you tell a patient they have a chronic medical condition that will require medical treatment. There's something about that first pill that is harder to swallow than any that follow. Whether it is pride or the realization that aging is real, most of us will come to this moment. Some in their 30's, others in their 80's. When that moment hits, be ready to discuss this important question with your doctor - WHAT CAN I DO OTHER THAN TAKE PILLS?

That's right! The first treatment for high blood pressure is NOT always medication (though in some cases it may need to be). In medical school, we were taught that lifestyle modification is almost always the first treatment. Of course, the problem is that no one really defined lifestyle modification. In other words: "Treat High Blood Pressure With Weight Loss." That's a big statement with a LOT to unwrap...exercise, diet, stress, nutrition, fitness levels, age...(and the list goes on)...

That's one thing we teach you at ShillMed - to be the athlete that your mother thinks you are - and to eat the way your body dreams of with healthy, fresh, whole foods. Of course, there's a LOT of nuance here, but that's for another blog post.

In many cases, a combination of strength training and cardiovascular exercise can impact your blood pressure enough to keep you off medications.

In fact, let's answer the question a little more directly:

"By what mechanisms does losing weight improve your blood pressure?

You can treat high blood pressure with weight loss because you:

1. Reduce Sympathetic Nervous System (SNS) Activity

Your nervous system responds to the state of obesity by ramping up into the "fight or flight" response, resulting in higher heart rates and clamping down on the blood vessels (vasoconstriction). The result? Higher blood pressure. These responses are part of the sympathetic nervous system, and studies show modest weight loss of 5-10% total body weight - especially visceral fat loss - leads to less sympathetic overactivity according to an article in Obesity Research & Clinical Practice. Another study in the Journal of Hypertension showed that your body may reward you with lower blood pressure just for trying to lose weight, even if you're not that successful!

2. Decrease Insulin Resistance

The debate rages as to whether insulin resistance causes obesity or obesity causes insulin resistance. I'm not entirely sure whether the chicken came before the egg, but one thing is clear - they feed each other. When you lose weight, your insulin sensitivity generally improves. That means you have less insulin racing around your blood, your pancreas doesn't have to work as hard, and your fat cells are less prone to increasing in size (in fact, they get smaller! That's why we can call it weight loss!)

In any case, as the quantity of insulin goes down in your body, you retain less water because high insulin signals the kidneys to hold on to sodium, and consequently, water. This results in a higher blood volume and that...begets higher blood pressure. Some evidence also suggests that the higher leptin levels lead to higher sodium retention by the kidneys as well. Guess where you find higher leptin (fullness or nutritional satisfaction hormone?) levels? In obesity! Check out this article from Gland Surgery for more details.

3. Turn down the Renin-Angiotensin-Aldosterone System

That's a lot to unpack - and this article in Gland Surgery does that pretty well. Suffice it to say that the adrenal glands and the kidneys manage blood pressure, and some of our most powerful high blood pressure medications work on this system. Losing weight can have an effect on this system similar to medications like lisinopril, losartan, and others.

Further, when you have obesity, your kidneys don't let go of sodium as well, which leaves more blood volume and higher blood pressure (see above if this sounds familiar). This article will help you understand the details a little better.

Why Weight Loss Matters & Why It Should Be First

My goal is not to disparage medication. It can be highly important. For example, if your blood pressure is higher than 150 systolic (the top number), we should probably do something to get it lower - at least temporarily - in order to keep you safe while you work on lifestyle changes that can last.

Also, don't forget that some people are just genetically endowed with higher blood pressure. You may not be able to lose enough weight or exercise consistently or hard enough to get your blood pressure back to normal. In that case, recognize that this is NOT a failure. Instead, know that this is a part of your story you must control with medication, but that doing so will help you keep other parts of your health in check. Health is a game like dominos...once one falls...well, you get the idea.

No matter who you are, no matter where you are in your health journey, consider the value of improving your lifestyle. Whether you've picked up 5 pounds or 50, consider choosing to treat rising or high blood pressure with weight loss.

What questions do you have about blood pressure? Drop a comment below, and we'll select a few to guide future blog posts.

Doctor Otto Shill, DO is a dual Board-Certified Internal Medicine and Obesity medicine doctor practicing in the Spokane Washington area. He is an expert in treating the underlying issues of complex medical conditions and using the treatment of metabolic disease to improve the overall outcomes of his patients. Please note that no doctor-patient relationship is formed by reading this blog and that you should discuss any potential changes to your healthcare plan with your own primary provider before making any modification to your personal plan of care.