Effect of body weight changes on 24-hour blood pressure and left ventricular mass in hypertension: a 4-year follow-up

Background Few data are available on the long-term effects of weight loss on 24-h blood pressure (BP) and left ventricular mass in overweight hypertensive patients. Methods A total of 181 never-treated overweight hypertensive subjects (body mass index, 25 to 39 kg/m2, office BP 145/94 ± 12/7 mm Hg) had 24-h BP monitoring and echocardiography twice, at baseline and after 3.8 ± 2 years (minimum 1 year). None of the subjects received antihypertensive drugs during the follow-up. Main outcome measures were changes in 24-h BP and in left ventricular mass. Results Percent change in body weight had a direct relationship with 24-h BP changes (r = 0.35 and 0.31 for systolic and diastolic BP, respectively; both P< .001). The associations with office BP changes (r = 0.13, P = .10 for systolic BP; r = 0.15, P = .06 for diastolic BP) were significantly weaker (both P< .01, z test). The patients who lost weight during follow-up (n = 106) had a significantly lower increase in 24-h BP (+0.6 ± 9/ +0.2 ± 6 v +4.9 ± 9/ +2.7 ± 7 mm Hg for systolic/diastolic BP, both P< .01) and in left ventricular mass (−3 ± 30 g v +9 ± 32 g, P< .02) than the remaining subjects. In a multiple linear regression, a 10% weight loss independently predicted a 4.3/3.8 mm Hg decrease in 24-h systolic/diastolic BP. Conclusions Long-term weight loss determines a sustained BP reduction during the 24 h and a decrease in left ventricular mass in overweight hypertensive subjects. The relation of weight loss with ambulatory BP changes is closer than that with office BP.