Long-term effects of weight-reducing diets in people with hypertension

Semlitsch, Thomas; Jeitler, Klaus; Berghold, Andrea; Horvath, Karl; Posch, Nicole; Poggenburg, Stephanie; Siebenhofer, Andrea

doi:10.1002/14651858.cd008274.pub3

Cited by 118Blood Pressure and Hypertension StudiesSodium Intake and HealthDiet and metabolism studies

Long-term effects of weight-reducing diets in people with hypertension

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Semlitsch, Thomas, Jeitler, Klaus, Berghold, Andrea, Horvath, Karl, Posch, Nicole, Poggenburg, Stephanie, Siebenhofer, Andrea·2016·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd008274.pub3PMC PMC7154764

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Abstract

BACKGROUND: All major guidelines for antihypertensive therapy recommend weight loss. Dietary interventions that aim to reduce body weight might therefore be a useful intervention to reduce blood pressure and adverse cardiovascular events associated with hypertension. OBJECTIVES: Primary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on all-cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non-serious adverse events). Secondary objectives To assess the long-term effects of weight-reducing diets in people with hypertension on change from baseline in systolic blood pressure, change from baseline in diastolic blood pressure, and body weight reduction. SEARCH METHODS: For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 3), Ovid MEDLINE, Ovid Embase, and ClinicalTrials.gov. We also contacted authors of relevant papers about further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of at least 24 weeks' duration that compared weight-reducing dietary interventions to no dietary intervention in adults with primary hypertension. DATA COLLECTION AND ANALYSIS: , we used a random-effects model. MAIN RESULTS: This second review update did not reveal any new trials, so the number of included trials remains the same: eight RCTs involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was 6 to 36 months. We judged the risks of bias as unclear or high for all but two trials. No study included mortality as a predefined outcome. One RCT evaluated the effects of dietary weight loss on a combined endpoint consisting of the necessity of reinstating antihypertensive therapy and severe cardiovascular complications. In this RCT, weight-reducing diet lowered the endpoint compared to no diet: hazard ratio 0.70 (95% confidence interval (CI) 0.57 to 0.87). None of the trials evaluated adverse events as designated in our protocol. The certainty of the evidence was low for a blood pressure reduction in participants assigned to weight-loss diets as compared to controls: systolic blood pressure: mean difference (MD) -4.5 mm Hg (95% CI -7.2 to -1.8 mm Hg) (3 studies, 731 participants), and diastolic blood pressure: MD -3.2 mm Hg (95% CI -4.8 to -1.5 mm Hg) (3 studies, 731 participants). We judged the certainty of the evidence to be high for weight reduction in dietary weight loss groups as compared to controls: MD -4.0 kg (95% CI -4.8 to -3.2) (5 trials, 880 participants). Two trials used withdrawal of antihypertensive medication as their primary outcome. Even though we did not consider this a relevant outcome for our review, the results of these RCTs strengthen the finding of a reduction of blood pressure by dietary weight-loss interventions. AUTHORS' CONCLUSIONS: In this second update, the conclusions remain unchanged, as we found no new trials. In people with primary hypertension, weight-loss diets reduced body weight and blood pressure, but the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials.

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Weight-reducing diets lower BP among patients with hypertension by 4.5/3.2 mm Hg in the most recent meta-analysis.
“Weight-reducing diets are well established to lower BP among patients with hypertension, by 4.5/3.2 mm Hg in the most recent meta-analysis.347”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [347]

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Research works printed but not linked: 35

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Davis BR, Blaufox MD, Hawkins CM, Langford HG, Oberman A, Swencionis C, et al. Trial of antihypertensive interventions and management. Design, methods, and selected baseline results. Controlled Clinical Trials 1989;10(1):11-30. [PUBMED: 2649308] *
Davis BR, Oberman A, Blaufox MD, Wassertheil-Smoller S, Hawkins CM, Cutler JA, et al. Effect of antihypertensive therapy on weight loss. The Trial of Antihypertensive Interventions and Management Research Group. Hypertension 1992;19(4):393-9. [PUBMED: 1555871]
Davis BR, Oberman A, Blaufox MD, Wassertheil-Smoller S, Zimbaldi N, Kirchner K, et al. Lack of effectiveness of a low- sodium/high-potassium diet in reducing antihypertensive medication requirements in overweight persons with mild hypertension. TAIM Research Group. Trial of Antihypertensive Interventions and Management. American Journal of Hypertension 1994;7(10 Pt 1):926-32. [PUBMED: 7826557]
Langford HG, Davis BR, Blaufox D, Oberman A, Wassertheil- Smoller S, Hawkins M, et al. Effect of drug and diet treatment of mild hypertension on diastolic blood pressure. The TAIM Research Group. Hypertension 1991;17(2):210-7. [PUBMED: 1671380
Oberman A, Wassertheil-Smoller S, Langford HG, Blaufox MD, Davis BR, Blaszkowski T, et al. Pharmacologic and nutritional treatment of mild hypertension: changes in cardiovascular risk status. Annals of Internal Medicine 1990;112(2):89-95. [PUBMED: 1967210]
Wassertheil-Smoller S, Blaufox MD, Oberman AS, Langford HG, Davis BR, Wylie-Rosett J. The Trial of Antihypertensive Interventions and Management (TAIM) study. Adequate weight loss, alone and combined with drug therapy in the treatment of mild hypertension. Archives of Internal Medicine 1992;152(1):131-6. [PUBMED: 1728908]
Wassertheil-Smoller S, Davis BR, Oberman A. The TAIM Study: Sex-race differences in effects of diet and drugs on cardiovascular risk. Cardiovascular Risk Factors 1991;1(7):427-35.
Wassertheil-Smoller S, Oberman A, Blaufox MD, Davis B, Langford H. The Trial of Antihypertensive Interventions and Management (TAIM) Study. Final results with regard to blood pressure, cardiovascular risk, and quality of life. American Journal of Hypertension 1992;5(1):37-44. [PUBMED: 1736933]
Wylie-Rosett J, Wassertheil-Smoller S, Blaufox MD, Davis BR, Langford HG, Oberman A, et al. Trial of antihypertensive intervention and management: greater efficacy with weight reduction than with a sodium-potassium intervention. Journal of the American Dietetic Association 1993;93(4):408-15. [PUBMED: 8454808]
TAIM 1992 combined {published data only} Blaufox MD, Lee HB, Davis B, Oberman A, Wassertheil-Smoller S, Langford H. Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy. JAMA 1992;267(9):1221-5. [PUBMED: 1538559]
Davis BR, Blaufox MD, Hawkins CM, Langford HG, Oberman A, Swencionis C, et al. Trial of antihypertensive interventions and management. Design, methods, and selected baseline results. Controlled Clinical Trials 1989;10(1):11-30. [PUBMED: 2649308] weight reduction by dietary intervention in overweight persons with mild hypertension. Archives of Internal Medicine 1993;153(15):1773-82. [PUBMED: 8333814]
Davis BR, Oberman A, Blaufox MD, Wassertheil-Smoller S, Hawkins CM, Cutler JA, et al. Effect of antihypertensive therapy on weight loss. The Trial of Antihypertensive Interventions and Management Research Group. Hypertension 1992;19(4):393-9. [PUBMED: 1555871]
Davis BR, Oberman A, Blaufox MD, Wassertheil-Smoller S, Zimbaldi N, Kirchner K, et al. Lack of effectiveness of a low- sodium/high-potassium diet in reducing antihypertensive medication requirements in overweight persons with mild hypertension. TAIM Research Group. Trial of Antihypertensive Interventions and Management. American Journal of Hypertension 1994;7(10 Pt 1):926-32. [PUBMED: 7826557]
Langford HG, Davis BR, Blaufox D, Oberman A, Wassertheil- Smoller S, Hawkins M, et al. Effect of drug and diet treatment of mild hypertension on diastolic blood pressure. The TAIM Research Group. Hypertension 1991;17(2):210-7. [PUBMED: 1671380
Oberman A, Wassertheil-Smoller S, Langford HG, Blaufox MD, Davis BR, Blaszkowski T, et al. Pharmacologic and nutritional treatment of mild hypertension: changes in cardiovascular risk status. Annals of Internal Medicine 1990;112(2):89-95. [PUBMED: 1967210
Wassertheil-Smoller S, Blaufox MD, Oberman AS, Langford HG, Davis BR, Wylie-Rosett J. The Trial of Antihypertensive Interventions and Management (TAIM) study. Adequate weight loss, alone and combined with drug therapy in the treatment of mild hypertension. Archives of Internal Medicine 1992;152(1):131-6. [PUBMED: 1728908]
Wassertheil-Smoller S, Davis BR, Oberman A. The TAIM Study: Sex-race differences in effects of diet and drugs on cardiovascular risk. Cardiovascular Risk Factors 1991;1(7):427-35.
Wassertheil-Smoller S, Oberman A, Blaufox MD, Davis B, Langford H. The Trial of Antihypertensive Interventions and Management (TAIM) Study. Final results with regard to blood pressure, cardiovascular risk, and quality of life. American Journal of Hypertension 1992;5(1):37-44. [PUBMED: 1736933]
Wylie-Rosett J, Wassertheil-Smoller S, Blaufox MD, Davis BR, Langford HG, Oberman A, et al. Trial of antihypertensive intervention and management: greater efficacy with weight reduction than with a sodium-potassium intervention. Journal of the American Dietetic Association 1993;93(4):408-15. [PUBMED: 8454808]
TAIM 1992 placebo {published data only} Blaufox MD, Lee HB, Davis B, Oberman A, Wassertheil-Smoller S, Langford H. Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy. JAMA 1992;267(9):1221-5. [PUBMED: 1538559]
Davis BR, Blaufox MD, Hawkins CM, Langford HG, Oberman A, Swencionis C, et al. Trial of antihypertensive interventions and management. Design, methods, and selected baseline results. Controlled Clinical Trials 1989;10(1):11-30. [PUBMED: 2649308] *
Davis BR, Oberman A, Blaufox MD, Wassertheil-Smoller S, Hawkins CM, Cutler JA, et al. Effect of antihypertensive therapy on weight loss. The Trial of Antihypertensive Interventions and Management Research Group. Hypertension 1992;19(4):393-9. [PUBMED: 1555871]
Davis BR, Oberman A, Blaufox MD, Wassertheil-Smoller S, Zimbaldi N, Kirchner K, et al. Lack of effectiveness of a low- sodium/high-potassium diet in reducing antihypertensive medication requirements in overweight persons with mild hypertension. TAIM Research Group. Trial of Antihypertensive Interventions and Management. American Journal of Hypertension 1994;7(10 Pt 1):926-32. [PUBMED: 7826557]
Langford HG, Davis BR, Blaufox D, Oberman A, Wassertheil- Smoller S, Hawkins M, et al. Effect of drug and diet treatment of mild hypertension on diastolic blood pressure. The TAIM Research Group. Hypertension 1991;17(2):210-7. [PUBMED: 1671380
Oberman A, Wassertheil-Smoller S, Langford HG, Blaufox MD, Davis BR, Blaszkowski T, et al. Pharmacologic and nutritional treatment of mild hypertension: changes in cardiovascular risk status. Annals of Internal Medicine 1990;112(2):89-95. [PUBMED: 1967210]
Wassertheil-Smoller S, Blaufox MD, Oberman AS, Langford HG, Davis BR, Wylie-Rosett J. The Trial of Antihypertensive Interventions and Management (TAIM) study. Adequate weight loss, alone and combined with drug therapy in the treatment of mild hypertension. Archives of Internal Medicine 1992;152(1):131-6. [PUBMED: 1728908]
Wassertheil-Smoller S, Davis BR, Oberman A. The TAIM Study: Sex-race differences in effects of diet and drugs on cardiovascular risk. Cardiovascular Risk Factors 1991;1(7):427-35.
Wassertheil-Smoller S, Oberman A, Blaufox MD, Davis B, Langford H. The Trial of Antihypertensive Interventions and Management (TAIM) Study. Final results with regard to blood pressure, cardiovascular risk, and quality of life. American Journal of Hypertension 1992;5(1):37-44. [PUBMED: 1736933]
Haynes B. RE: Cochrane Review [personal communication]. Email to: A Siebenhofer. 10 December 2010.

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“5-mmHg and 3-mmHg reduction in SBP and DBP, respectively.(18) Results from this review would underestimate expected outcomes of this trial.”
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“53 Weight-reducing medications such as glucagon-like peptide 1 receptor agonists are also effective in improving BP.”
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“A recently updated Cochrane review of weight loss diets in populations with hypertension identified eight trials with 2100 participants on which to base their analysis [25].”
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BackgroundSelf-citation
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Background
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Background
Comparison of lifestyle changes and pharmacological treatment on cardiovascular risk factors
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Background
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Investigation and management of resistant hypertension: British and Irish Hypertension Society position statement
Faconti, L., George, J., Partridge, S., Maniero, C., Sathyanarayanan, A., Kulkarni, S., Kapil, V., Petrosino, A., Lewis, P., McCormack, T., et al. (2024) · Journal of Human Hypertension · doi:10.1038/s41371-024-00983-6 · Cited by 21 · see citing works
Resistant Hypertension Updated Guidelines
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The Effect of Head and Neck Radiotherapy on Blood Pressure and Orthostatic Hypotension in Patients With Head and Neck Tumors
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Resistant hypertension: diagnosis, evaluation, and treatment a clinical consensus statement from the Thai hypertension society
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BackgroundMethod
Lifestyle modification strategies for controlling hypertension: How are these strategies recommended by physicians in Iran?
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Long-term effects of weight-reducing diets in hypertensive patients
Siebenhofer, A., Jeitler, K., Berghold, A., Waltering, A., Hemkens, L. G., Semlitsch, T., Pachler, C., Strametz, R., & Horvath, K. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008274.pub2 · Cited by 121 · see citing works
Self-citation
Dieting to reduce body weight for controlling hypertension in adults
Mulrow, C. D., Chiquette, E., Angel, L., Cornell, J., Summerbell, C. D., Anagnostelis, B., Brand, M., & Grimm, R. H. (1998) · Nursing Times · doi:10.1002/14651858.cd000484 · Cited by 70 · see citing works
Retracted
Long-term effects of weight-reducing drugs in people with hypertension
Spary-Kainz, U., Posch, N. A. S., Radl-Karimi, C., Jeitler, K., Krenn, C., Siebenhofer, A., Berghold, A., Horvath, K., Winterholer, S., & Semlitsch, T. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007654.pub6
Self-citation
Long-term Effects of Weight-Reducing Interventions in Hypertensive Patients Systematic Review and Meta-analysis
Horvath, K. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.6.571 · Cited by 141 · see citing works
Self-citation
Long-term effects of weight-reducing drugs in hypertensive patients
Siebenhofer, A., Horvath, K., Jeitler, K., Berghold, A., Stich, A. K., Matyas, E., Pignitter, N., & Siering, U. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007654.pub2 · Cited by 32 · see citing works
Self-citation

Authors: Semlitsch, T., Jeitler, K., Berghold, A., Horvath, K., Posch, N., Poggenburg, S., & Siebenhofer, A.
Affiliations: Medical University of Graz (AT)
Goethe University Frankfurt (DE)
ORCID: Semlitsch, Thomas
Jeitler, Klaus
Berghold, Andrea
Horvath, Karl
Posch, Nicole
Poggenburg, Stephanie
Siebenhofer, Andrea
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2016-03-02
Volume: 2
Pages: CD008274-CD008274
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd008274.pub3
PMC: PMC7154764
OpenAlex: W2290414732
Cited by: 118
References: 154
Citations by year: 2026: 1 · 2025: 10 · 2024: 10 · 2023: 10 · 2022: 15 · 2021: 18 · 2020: 16 · 2019: 16 · 2018: 10 · 2017: 9 · 2016: 2 · 2015: 1
FWCI: 2.14
Type: journal article
Language: en
Update notices: new_version (2021-02-08)
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Health Sciences › Medicine › Physiology › Diet and metabolism studies
Keywords: hypertension, weight loss diet, dietary weight loss, blood pressure reduction, cardiovascular morbidity, all-cause mortality, adverse events, weight loss, antihypertensive therapy, essential hypertension, long-term effects, cardiovascular complications, antihypertensive withdrawal, risk of bias, quality of evidence
MeSH terms: Aged, Blood Pressure, Cardiovascular Diseases, Diet, Reducing, Humans, Hypertension, Middle Aged, Weight Loss, Randomized Controlled Trials as Topic

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Long-term effects of weight-reducing diets in people with hypertension

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