Feeling the Pressure: Hypertension and Obesity

Dr. Christopher McGowan
November 30, 2020

Heart attacks and strokes can seem like sudden and unexpected events. In the moments after a stroke or heart attack, every second counts to save your life, let alone keep your heart, brain, and other organs from suffering damage. Though it takes seconds for things to go wrong, the lead up to heart disease usually involves years of unhealthy habits. 

If you are overweight, there is a chance a doctor or other health care provider has already talked to you about the dangers of obesity. Research has shown that carrying excess body weight can increase your chances of encountering many different deadly conditions and diseases from strokes to type 2 diabetes to kidney disease. One common link among all of these is the presence of high blood pressure. 

What is High Blood Pressure?

High blood pressure, or hypertension, is a condition where the pressure exerted by your blood against the walls of your blood vessels is higher than it should be. Blood pressure, like the measurement of other kinds of fluid pressure in other branches of medicine and science, is measured in millimeters of mercury or "mm Hg." Two numbers make up your blood pressure reading; the first, called systolic blood pressure, is the higher number and the second, lower number is diastolic pressure. Systolic pressure is the measurement of pressure on the walls of your arteries when your heart beats. Diastolic blood pressure measures the force on your arteries when your heart is temporarily at rest between beats. These two numbers are typically written as a fraction such as "130/80."

The American Heart Association (AHA) publishes guidelines for the different levels of risk of high blood pressure. These guidelines divide people up into five categories of risk based on their blood pressure readings:

  • Normal – Under 120/08 mm Hg
  • Elevated – 120-129 (systolic) but less than 80 (diastolic)
  • Hypertension Stage 1 – 130-139 (systolic) or 80-89 (diastolic)
  • Hypertension Stage 2 – 140 or higher (systolic) or 90 or higher (diastolic)
  • Hypertensive Crisis – 180 or higher (systolic) and/or 120 or higher (diastolic) 

Previously, blood pressure readings in the middle of the range placed you in a category named prehypertension, but this designation was eliminated in 2018 by the AHA in favor of the breakdown listed above. 

If you have reached the hypertensive crisis stage and see repeated blood pressure readings such as 180/120, you should contact your doctor immediately. At this stage you are considered to be at imminent risk of cardiovascular disease and are in need of immediate medical attention. If you have readings this high and are experiencing any of the typical signs of heart failure such as shortness of breath, change of vision, back pain, chest pain, or difficulty speaking, call 911 immediately. 

How Does Weight Affect Blood Pressure?

Being overweight and having high blood pressure are very tightly linked for many reasons. To begin with, your heart has to pump more blood to supply excess fatty tissue, which increases the pressure on vascular tissue throughout the body. Visceral fat stored around your kidneys can impair kidney function and increase tubular sodium reabsorption, which is linked to high blood pressure. Obesity is also linked to increased insulin resistance, which also contributes to high blood pressure. Additionally, excess weight increases your vascular resistance, which means your heart has to work harder to push blood throughout your body. Even a lowered level of physical activity, common among people who are overweight, can increase your chances of high blood pressure and heart disease. 

Though nearly everyone has heard that having high blood pressure is bad for you, probably fewer people understand how elevated blood pressure affects your health. Fewer still have probably heard exactly why being overweight is one of the greatest risk factors for high blood pressure. As noted above, there are several ways in which being overweight can affect your cardiovascular system and other organs in the body. 

The accumulation of visceral adipose tissue (VAT) throughout your body, but particularly around the kidneys, is one area where the effects of being overweight can be seen. Fat cells can secrete hormones that disrupt something called the renin-angiotensin-aldosterone system (or RAAS) that manages salt levels in your body. Disturbances in this balance can result in your kidneys working harder to keep salt levels in check. Compounding this problem is the raw physical pressure your kidneys can be placed under by excess fatty tissue. Too much fat around the kidneys can disrupt blood flow, making it even harder for your kidneys to do their job. This strain can eventually lead to a higher chance of kidney disease. 

VAT can also lead to an increase in insulin resistance, which is one of the other main ways extra weight can lead to elevated blood pressure. Increased insulin resistance, which can lead to type 2 diabetes over time, can result in overactivation of your sympathetic nervous system, which controls blood pressure by expanding and contracting the size of your peripheral arteries. Overstimulation of your sympathetic nervous system can impair the normal regulation of blood pressure, contributing to hypertension.

Can You be Skinny and Have High Blood Pressure?

Obesity is by no means the only cause of high blood pressure, though it is one of the most obvious risk factors. Genetics, diet, lack of exercise, alcohol consumption, and stress can all play a part in making people susceptible to hypertension no matter how much they weigh. Where diet is concerned, it is likely that poor eating habits will also lead to weight gain, but it is still possible for people eating a diet high in salt and fried foods to be at increased risk of heart disease even if they are maintaining what is normally considered to be a healthy weight.

In the United States it can feel like we are all fighting an uphill battle against high blood pressure. The prevalence of chronic stress, low levels of aerobic physical activity, and diets high in potassium and unhealthy fats are all so common that blood pressure control is difficult for many people regardless of their weight. Even if weight reduction isn’t part of the goals your doctor has set out for you to lower your blood pressure, it is likely that the same dietary and lifestyle changes will be recommended if your blood pressure readings are too high. 

How Does Weight Loss Affect Blood Pressure Levels?

The good news is, simple lifestyle changes that help you lose weight can have a direct and measurable impact on your cardiovascular health. It has been shown that losing weight, even if it is only a few pounds, can put you on the path to lower blood pressure. Dropping even as few as nine pounds can bring your systolic pressure down by 4.5 mm Hg. 

It is also good to keep in mind that you do not need to necessarily hit a particular number on the scale to guarantee you have made progress in lowering your blood pressure. Increasing your level of physical activity, eating a diet rich in fruits and vegetables and lower in salts, sugars, and fried foods will also help to bring down your blood pressure. 

Dietary changes are usually a part of lowering your blood pressure, but they are also not the whole picture. Physical activity that includes aerobic workouts will likely be a part of your doctor’s recommendations for lowering your blood pressure. This doesn’t mean you should go out and start trying to pound out hours on the treadmill overnight. It is important to be very careful when you begin any exercise program as you do not want to overdo it early, especially when your cardiovascular system is still unhealthy. Until you can lower your blood pressure and start getting your heart in shape, trying to do too much too fast could actually put you at a greater risk of cardiovascular disease. 

What Weight Goal Should You Have to Lower Blood Pressure?

With any health related weight loss program, talking to your doctor and setting reasonable, tailored goals that fit your needs and your body is more important than hitting an arbitrary number. Some people use the body mass index, or BMI, as a start to determine weight loss goals, but this does not take into account many of the factors of body composition.

That said, studies have shown that having a BMI over 30, which is considered obese, is linked to a significantly higher risk of high blood pressure and heart disease. Setting an initial goal to get your BMI into the 20s is a very good place to start. Beyond that, as you work with your doctor to set goals for your blood pressure and weight, you can begin to find a healthy weight and a healthy lifestyle you can maintain that will keep your cardiovascular risk in check.

Blood Pressure Levels During Pregnancy

Some weight gain is normal during pregnancy, but having excess body weight before you become pregnant can contribute to problems with high blood pressure during gestation. Measuring your weight during pregnancy is one of the many reasons it is so important to work as closely as possible with your doctor to make sure you are doing the best you can for your body and for your baby. 

High blood pressure during pregnancy has been linked to a range of conditions including placental abruption, premature delivery, and cardiovascular disease. It is important to note that there are several types of high blood pressure that can accompany pregnancy including gestational hypertension, chronic hypertension, and preeclampsia.

Treating Hypertension

Maintaining a healthy lifestyle, focusing on healthy eating, and losing weight if you are carrying a few too many pounds are some of the most important things you can do to manage or avoid high blood pressure. For some people, these habits are either not enough or may take too long to get in place to prevent your doctor from being concerned about your blood pressure. In these cases, antihypertensive drugs have been developed to bring your blood pressure down until your lifestyle can help keep you out of danger.

Your doctor will go through a systematic review of all your health information. This can include your family history to look for increased risks of heart disease or other risk factors that could put you in a higher level of concern for developing cardiovascular disease. If your doctor finds that you are at increased risk, he or she may recommend blood pressure control medication in addition to weight loss and dietary approaches to stop hypertension. The main categories of these medications, and a few samples of each, are listed below:

  • ACE inhibitors: benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexioril (Univasc)
  • Angiotensin II Receptor Blockers: candesartan (Atacand), irbesartan (Avapro), olmesartan (Benicar), telmisartan (Micardis)
  • Diuretics: amiloride (Midamor), eplerenone (Inspra), furosimide (Lasix), hydrochlorothiazide (Esidrix, Microzide), metolazone (Zaroxolyn) 
  • Alpha blockers: They include clonidine (Catapres), doxazosin​​​​​​​ (Cardura),  guanfacine (Tenex), prazosin (Minipress), terazosin (Hytrin)
  • Beta-blockers: acebutolol (Sectral),  bisoprolol (Zebeta), carvedilol (Coreg)  
  • Calcium Channel Blockers: amlodipine (Norvasc), felodipine​​​​​​​ ( Plendil), nicardine (Cardene), nisoldipine (Sular)
  • Vasodilators: Minoxidil, Hydralazine

Weight Loss Surgery and Hypertension

Many people who are chronically overweight would like to have a different relationship with their body. If you have weight gain induced high blood pressure, losing weight goes beyond aesthetic concerns of how you look or even the desire to be more active. Extremely high blood pressure can make losing weight a truly life or death decision. 

The importance of losing weight if you are obese can seem daunting or even defeating if it seems you have tried everything you can to lose weight through changes in diet, lifestyle, and exercise alone. If you are in this position, don’t lose hope. There are other options to help you get to a healthy weight and lower your cardiovascular risk. 

If you have a BMI of over 30, have tried diet and exercise to control your weight, and are not finding success, you may be a candidate for a weight loss procedure. Historically, weight loss surgeries such as a gastric lap band or a full gastric bypass were considered the best options for helping people permanently lose weight. Long term data now shows that these surgeries can have dangerous complications down the road. Perhaps equally concerning is the fact that as many as 20% of patients who undergo an irreversible surgery such as a gastric bypass still gain back their excess body weight over the first decade after surgery. 

Thankfully, there are now more alternatives available that have similar initial results to a gastric bypass but do not carry the same risk of the more worrying side effects later in life. Some of these procedures are even reversible, further reducing their potential for long-term negative consequences. These include:

  • ESG – Endoscopic Sleeve Gastroplasty
  • Medical Nutrition Therapy
  • ORBERA® Managed Weight Loss System

In a traditional gastric bypass surgery, the size of your available stomach is drastically reduced, but over time the new, smaller stomach can stretch. This allows you to eat more calories and could cause you to gain weight. If you are in this position, it may be time to consider a gastric revision to restore your new stomach pouch to its intended size. This can be done in a minimally invasive procedure that has a far shorter recovery time than your original surgery. 

If you are feeling as though you are out of options to lose weight, and your doctor has made it clear that you must do something about your obesity-induced high blood pressure, it may be time to consider a weight loss procedure. Request a consultation today to see if you might be a candidate for a weight loss procedure or program such as our medical nutrition therapy. Freedom from the dangers of high blood pressure could be right around the corner.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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