Weight Loss Strategies and High Blood Pressure: What Works?

When a patient has high blood pressure, one of the first things I look at is their weight. Being overweight or obese is so often associated with high blood pressure that weight loss is actually recommended in major guidelines for care as a standard first line of treatment. Along with simply dieting (consuming fewer calories), right now there are several prescription and over-the-counter medications to help with weight loss. We know that all sorts of strategies, from silly to sane, will help you lose weight. Which ones will help with your blood pressure, as well?

Researchers in Germany and Austria analyzed the results from 48 published articles on the subjects of blood pressure and weight loss (Arch Intern Med. 2008;168(6):571-580). Thirty-eight of those articles investigated the effects of a change in diet on weight loss and blood pressure, while the other ten publications looked at the effects of two medications on weight loss and blood pressure.

The two medications investigated in those ten articles have the chemical names of orlistat and sibutramine. Orlistat used to be available by prescription only as a medication called Xenical, and is now available over the counter as Alli. It works by interfering with the body's absorption of fat and can cause diarrhea. Sibutramine, however, is still prescription-only and is known as Meridia. It works by reducing one's perception of hunger and can sometimes cause increases in blood pressure.

The researchers reviewing these results note that most of the studies suffered from major analytical and procedural problems, in their view. These issues included lack of blinding as well as problems with the way the results were analyzed and reported in the original article. Several were funded by the pharmacological industry, as well.

That said, those study subjects lost more weight on one of the three interventions (dieting, Alli, or Meridia), than they did when given a placebo or not instructed on reducing caloric intake. However, those who were taking Meridia did not reduce their blood pressure - and in fact, their systolic blood pressure actually increased.

What this means for you

Overweight and obesity are related to so many health issues that being a healthy weight is one of the single best things you can do for your health. While taking diet pills like Alli or Meridia might seem like a way to make weight loss effortless, I don't think the possible side effects are worth it: increased blood pressure (in the case of Meridia), or persistent diarrhea (in the case of Alli). Why not just eat good, healthy food?