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Rapid response to:

Education And Debate

British Hypertension Society guidelines for hypertension management 1999: summary

BMJ 1999; 319 doi: (Published 04 September 1999) Cite this as: BMJ 1999;319:630

Rapid Response:

Treating hypertension with lifestyle measures: Aim for modest weight loss, not ‘ideal body weight’

The authors of the recent guidelines for the treatment of
hypertension are to be congratulated on producing a clear and
authoritative document. However the section on lifestyle modification
includes the statement that weight loss 'to achieve an ideal body weight'
will lower blood pressure. Whilst this is undoubtebdly true, it
undermines most recent guidelines (1-3) that recognise the practical near-
impossibility of achieving ideal body weight in most obese subjects and
evidence that suggests that more modest (and achievable) reductions in
weight of 5-10% of body weight can be effective at lowering systolic and
diastolic blood pressure in the range of 4-7 and 3-6 mmHg respectively (4,
5). It should be made explicit in the guidelines that this degree of
weight loss is likely to be beneficial in reducing cardiovascular risk,
rather than perpetuating the myth that ‘ideal’ body weight is a realistic
goal of lifestyle modification in overweight and obese subjects.

Conflict of interest: Both authors have received honoraria for speaking at lectures, consultancy fees and have been involved with a number of companies that produce, or a re developing, pharmacological treatments for obesity.

1. Royal College of Physicians. Clinical management of overweight
and obese patients, with particular reference to the use of drugs. 1998

2. Obesity in Scotland: Integrating Prevention with Weight Management
SIGN 1996

3. Clinical Guidelines on the identification, evaluation and treatment of
overweight and obesity in adults. National Institutes of Health 1998

4. The Treatment of Mild Hypertension Research Group (1991) The treatment
of mild hypertension study. A randomized, placebo-controlled trial of a
nutritional-hygienic regimen along with various drug monotherapies. Arch.
Intern. Med. 151, 1413-1423.

5. Trials of Hypertension Collaborative Research Group (1997).
Effects of
weight loss and sodium reduction intervention in blood pressure incidence
overweight people with high-normal blood pressure: the Trials of
Hypertension Prevention, phase 2. Arch. Int. Med. 157 657-667

Competing interests: No competing interests

08 September 1999
John Wilding
Senior Lecturer in Medicine, Professor
Gareth Williams
University Clinical Departments, University Hospital Aintree, Liverpool L9 7AL