Effect of weight loss on blood pressure changes in overweight patients: A systematic review and meta-analysis

Impact of a Chokeberry (Aronia melanocarpa (Michx.) Elliott) Supplementation on Cardiometabolic Outcomes: A Critical Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: Chokeberry (Aronia melanocarpa (Michx.) Elliott) is a (poly)phenol-rich fruit with purported cardiometabolic benefits. However, the evidence from randomized controlled trials (RCTs) remains inconclusive. This systematic review and meta-analysis aimed to assess the effects of chokeberry supplementation on cardiometabolic outcomes, including anthropometric parameters, glycemic control, lipid profile, and blood pressure in adults. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science through January 2025. RCTs investigating chokeberry supplementation (≥2 weeks) in adults (≥18 years) with or without cardiometabolic risk factors were included. A random effects model was used to pool effect sizes, expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic, and risk of bias was evaluated with the Cochrane risk of bias 1 (RoB 1) tool. Trial sequential analysis (TSA) was performed to assess the conclusiveness of the evidence. Certainty of evidence was rated using GRADE. Results: Ten RCTs (n = 666 participants) met the inclusion criteria. Chokeberry supplementation had no significant effects on cardiometabolic outcomes under evaluation. Subgroup analysis suggested that a chokeberry supplementation could reduce total cholesterol and LDL-C in individuals with a baseline total plasma cholesterol <200 mg/dL, and systolic blood pressure with interventions, containing >50 mg/day anthocyanin, while increasing fasting blood glucose in individuals ≤50 years old. Risk of bias was unclear or high in several studies, TSA indicated inconclusive evidence for most outcomes, and the certainty of evidence was rated as very low across all cardiometabolic markers. Conclusions: Chokeberry supplementation did not significantly improve cardiometabolic outcomes in the general adult population. Limited evidence is given for potential lipid-lowering and blood pressure effects in specific subgroups. However, a high risk of bias accompanies these results. More robust RCTs with standardized interventions and dietary assessments are needed.

Role of Incretin Mimetics in Cardiovascular Outcomes and Other Classical Cardiovascular Risk Factors beyond Obesity and Diabetes Mellitus in Nondiabetic Adults with Obesity: a Meta-analysis of Randomized Controlled Trials

BACKGROUND

Emerging data on cardiovascular outcomes, specifically major adverse cardiovascular events (MACE), are being reported from various trials involving incretin mimetics, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) and glucose-dependent insulinotropic polypeptide (GIP), especially among patients with obesity and diabetes. Our aim was to evaluate this matter, while also involving various traditional cardiovascular risk factors [e.g., several body weight (BW) parameters, blood pressure (BP), lipid profile].

METHODS

A search of PubMed, Europe PMC, ScienceDirect, Cochrane, and ClinicalTrials.gov up to September 2024 was performed to identify GLP-1 RA and GIP trials in MACE risk reduction as a primary endpoint. Our secondary endpoints included a reduction in BW, waist circumference (WC), body mass index (BMI), BP changes, and lipid modifying effects, while also yielding safety concerns surrounding the use of these pharmaceutical agents. Mean differences (MD) and risk ratios (RR) were summarized using random-effects model.

RESULTS

A total of 11 eligible randomized controlled trials (RCTs) comprising 8 GLP-1 RA trials and 3 dual GLP-1 RA/GIP (tirzepatide) trials were included. Compared with control groups, GLP-1 RA significantly reduced the MACE risk by 32% [RR 0.68 (95% CI 0.53-0.87); P = 0.002; I2 = 73%, P-heterogeneity < 0.001] and 59% for tirzepatide [RR 0.41 (95% CI 0.18-0.92); P = 0.03; I2 = 0%, P-heterogeneity = 0.96]. Incretin mimetics also substantially reduced BW, BP, and improved lipid panel measures. However, there was an increased risk of adverse events, specifically gastrointestinal disorders within the incretin mimetics subset.

CONCLUSIONS

Incretin mimetics have shown promise in reducing MACE risk while also enhancing cardiovascular risk factors, including blood pressure and lipid profile, in adults with obesity without diabetes.

The Effects of a Whole-Food Plant-Based Nutrition Education Program on Blood Pressure and Potassium in Chronic Kidney Disease: A Proof-of-Concept Study

BACKGROUND/OBJECTIVES

Whole-food plant-based diets (WFPBDs) are beneficial in managing hypertension in the general population but have not been well studied in chronic kidney disease (CKD), potentially due to concerns about hyperkalemia. We hypothesized that individuals with CKD 3 or 4 attending a 15-day WFPBD education program would achieve lower blood pressure compared to those who did not, without an increased risk of hyperkalemia.

METHODS

This was a pilot trial of 40 subjects with mild-to-moderate CKD and hypertension but without diabetes or proteinuria from a single academic center. The subjects were randomized to the 15-day education program or the control group. The changes in blood pressure, serum potassium, and other anthropometric and biochemical values were assessed.

RESULTS

Systolic blood pressure decreased from the baseline to day 15 in the intervention group by 8 mm Hg and increased in the control group by 2.7 mm Hg, although the difference in the blood pressure change did not reach statistical significance (p = 0.12). Diastolic blood pressure was not different between the two groups. Potassium changed by 0.01 mEq/L in the intervention group and -0.07 mEq/L in the control group (p = 0.52). The intervention subjects had significant decreases in body mass (-3.0 vs. -0.12 kg, p < 0.0001), total cholesterol (-39.4 vs. -5.0 mg/dL, p < 0.0001), low-density lipoprotein (-28.4 vs. -0.6 mg/dL, p < 0.0001), and high-density lipoprotein (-8.6 vs. -0.4 mg/dL, p = 0.006) compared to the controls. The changes in albumin and phosphorus were not different between the two groups.

CONCLUSIONS

The subjects with mild-to-moderate CKD attending a 15-day WFPBD education program had a non-statistically significant reduction in systolic blood pressure without an increased risk of hyperkalemia compared to those who did not attend. The intervention subjects achieved significantly greater reductions in body mass and cholesterol without adverse effects on albumin or phosphorus. Larger and longer-duration trials using this approach in a diverse group of CKD patients are warranted.

Association between self-reported weight loss and new long-term care insurance certifications: A 9-year Japanese older adult cohort study

AIM

This cohort study aimed to assess weight loss associated with new long-term care insurance (LTCI) certifications over a 9-year period, accounting for the competing risk of death.

METHODS

We analyzed data from 3749 Japanese individuals aged ≥65 years in Kami Town, Hyogo Prefecture, Japan. Weight loss was assessed using the Kihon Checklist during the baseline survey. Data regarding LTCI certifications were collected until March 2022. Cox proportional hazards models were used to calculate adjusted hazard ratios (HRs) of 9-year LTCI certification because of weight loss, adjusted for confounding factors. To exclude the effect of competing risks, Fine-Gray regression was used to estimate subdistribution HRs. Subgroup analyses were carried out after the examination of potential interactions between subjective cognitive function, body mass index categories and weight loss.

RESULTS

The incidence rate of new LTCI certifications was 5.16 per 100 person-years overall - broken down into 7.02 for those with weight loss and 4.97 for those without. The adjusted HR for weight loss to new LTCI certifications was 1.35 (95% CI 1.15-1.59). Considering mortality as a competing risk, the adjusted subdistribution HR was 1.37 (95% CI 1.16-1.61). Conversely, no interaction was observed between weight loss and subjective cognitive function or body mass index categories.

CONCLUSIONS

Excluding the effect of mortality, weight loss was identified as a risk factor for new LTCI certifications. However, no interaction was observed between weight loss and subjective cognitive function or body mass index categories. Geriatr Gerontol Int 2024; 24: 1320-1327.

Assessment and Management of Patients with Obesity and Hypertension in European Society of Hypertension Excellence Centres. A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors

BACKGROUND

Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs).

METHODS

We conducted a cross-sectional, international 30-item survey through e-mails.

RESULTS

In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors.

CONCLUSION

Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

Optimal blood pressure control with fewer antihypertensive medications: Achieved mostly in low-risk hypertensive patients

Recent studies indicate that intensive blood pressure (BP) targets can be reached with less than two medications. This cross-sectional study, involving 4991 individuals from the Majiapu community, assessed the correlation between BP control and the burden of antihypertensive drugs. Participants on medication were categorized into controlled (BP < 140/90 mm Hg) and uncontrolled (BP ≥ 140/90 mm Hg) groups, with the former further divided into optimal (BP < 130/80 mm Hg) and good control (BP < 140/90 but >130/80 mm Hg) subgroups. Multivariate logistic regression analyzed factors affecting hypertension control across these BP categories. The study found that, 54% of participants had hypertension. Of those treated (62.5%), 55.7% achieved BP control, including 23.15% maintaining BP below 130/80 mm Hg. The average number of antihypertensive medications was 1.61 for the controlled group (with an average BP of 126.6/76 mm Hg) and 1.75 for the uncontrolled group (with an average BP of 150.6/84.0 mm Hg). Additionally, the average number of antihypertensive medications was 1.66 in the good control group and 1.55 in the optimal control group. The uncontrolled group had a higher mean systematic coronary risk estimation (SCORE) of 5.59, against 3.97 and 2.5 in the good and optimal control groups, respectively. Key factors linked to poor BP control included age over 65, male sex, obesity, and former smoking, whereas lipid-lowering medication use was associated with better control. In conclusions, patients needing fewer antihypertensive drugs to achieve stricter targets may have a lower risk profile. Notably, only a small proportion of treated patients are low-risk individuals who can easily achieve BP levels below 130/80 mm Hg.

Combination of diethylpropion with dietary intervention results in body weight and fat loss with preserved muscle mass in obese patients

Combining pharmacotherapy with lifestyle intervention is recommended for obese class II patients who fail lifestyle therapy and for obese class I patients. Diethylpropion, an obesity medication, has been approved for use in Indonesia, which is an Asia-Pacific country. This retrospective study aimed to assess the short-term effects of diethylpropion on weight and fat loss in obese patients in Indonesia. Secondary data were collected from 142 patients' medical records with a body mass index ≥ 25 kg/m2 who underwent short-term diethylpropion treatment for 84 days between January 2022 and November 2023 at the Kimia Farma Nutrition Clinic in Bandung, Indonesia. Blood pressure, body weight, height, waist circumference, and body composition were assessed at each follow-up visit to determine the fat and muscle mass. Patients were prescribed diethylpropion 25 mg 3 times daily every 2 weeks together with dietary intervention. Kruskal-Wallis test was used to analyze the changes in body weight, skeletal muscle, fat mass, and waist circumference after the diethylpropion therapy. Mann-Whitney test was used for the relation between age, sex, and body mass index with weight loss on the last day of follow-up. Simple linear regression analysis was also performed to identify the correlation between weight loss and therapy duration. This study showed body weight reduction of up to 9.5 ± 3 kg (10 ± 0.0%) (P = .008) on 84 days of treatment. Significant fat loss 11.5 ± 4.6 kg (20.5 ± 0.0%) (P = .005) was also reported in our study without significant loss of muscle mass -2.4 ± 4.6 kg (3.6 ± 1.3%) (P = .58). Waist circumference was insignificantly reduced by 5.6 ± 0.0 cm (4.9 ± 2.8%) (P = .21) after 84 days of diethylpropion therapy. This study revealed no significant changes in patient systolic and diastolic pressures despite showing mild increases after 70 days. The combination of diethylpropion and an appropriate diet resulted in weight loss accompanied by significant fat loss and preserved muscle mass without an increase in blood pressure during the 12-week treatment period.

Obesity and hypertension in children and adolescents

As childhood obesity rates increase worldwide, the prevalence of obesity-related hypertension is also on the rise. Obesity has been identified as a significant risk factor for hypertension in this age group. National Health Surveys and meta-analyses show increasing trends in obesity and pediatric hypertension in obese children. The diagnosis of hypertension in children involves percentiles relative to age, sex, and height, unlike in adults, where absolute values are considered. Elevated blood pressure (BP) in childhood is consistently associated with cardiovascular disease in adulthood, emphasizing the need for early detection and intervention. The pathogenesis of hypertension in obesity involves multiple factors, including increased sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system (RAAS), and renal compression due to fat accumulation. Obesity disrupts normal RAAS suppression and contributes to impaired pressure natriuresis and sodium retention, which are critical factors in the development of hypertension. Risk factors for hypertension in obesity include degree, duration, and distribution of obesity, patient age, hormonal changes during puberty, high-sodium diet, sedentary lifestyle, and socioeconomic status. Treatment involves lifestyle changes, with weight loss being crucial to lowering BP. Medications such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may be considered first, and surgical approaches may be an option for severe obesity, requiring tailored antihypertensive medications that consider individual pathophysiology to avoid exacerbating insulin resistance and dyslipidemia.

Efficacy of a Benincasa hispida powdered drink in improving metabolic control in patients with type 2 diabetes: A placebo-controlled study

Objectives

There is emerging evidence of the benefits of Benincasa hispida in improving metabolic profiles in people with diabetes. This study was conducted to analyze the effect of B. hispida aqueous extract on the metabolic control of patients with type 2 diabetes in Malaysia.

Methods

A powdered drink formulated with 2.5 g of B. hispida extract was prepared as a test food. An intervention study was conducted with 50 participants randomly assigned to an intervention or a control group. Anthropometric, biochemical, and clinical variables were assessed at baseline and week 12 after intervention. Paired T-tests were applied to compare the mean differences between the baseline and post-intervention for each variable.

Results

The intervention group presented a significant reduction in diastolic blood pressure (Δ -7.0 mmHg, 95% confidence interval [CI]: -11.4, -2.5). Mean fasting plasma glucose (Δ -0.8 mmol/L, 95% CI: -1.8, 0.2) showed a greater reduction in the intervention group compared to the control group (Δ -0.4 mmol/L, 95% CI: -1.2, 0.4). Mean lean body mass showed a favorable trend of increment at week 6 (Δ 0.05 kg, 95% CI: -0.40, 0.49) and week 12 (Δ 0.16 kg, 95% CI: -0.33, 0.64) as compared to baseline in the intervention group but not in the control group which manifested decreasing lean body mass.

Conclusion

The use of B. hispida extract may potentially improve blood pressure and glycemic control in patients with type 2 diabetes and it may be an attractive candidate for the development of functional food products.

Long-Term Impact of Nutritional Intervention with Increased Polyphenol Intake and Physical Activity Promotion on Oxidative and Inflammatory Profiles in Patients with Metabolic Syndrome

Obesity and overweight pose significant risks to health, contributing to the prevalence of chronic conditions like type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). The current study aimed to assess the impact of a 6-year nutritional and lifestyle intervention on oxidative and inflammatory markers in individuals aged 55 to 75, specifically those at high risk of CVD. A study was carried out in a group of 80 participants with metabolic syndrome (MetS) residing in Mallorca, Spain, who underwent nutritional intervention based on a low-calorie Mediterranean diet (MedDiet) and promotion of physical activity. Before and after the intervention, several parameters including anthropometric data, haematological factors, blood pressure, and physical activity level were measured. Oxidative and inflammatory biomarkers in plasma were analysed. After the 6-year intervention, participants who managed to reduce their body mass index (BMI) had greater reductions in abdominal obesity, waist to heigh ratio (WHtR), diastolic blood pressure, and glucose levels, and increased high density protein cholesterol (HDL-c) compared to those who did not reduce BMI. This higher reduction in BMI was related to reduced energy intake and increased adherence to MedDiet, with greater polyphenol intake, and total physical activity (PA). Furthermore, improvements in oxidative stress and proinflammatory status were observed in participants who reduced their BMI. Significant reductions in the activity of the prooxidant enzyme, myeloperoxidase (MPO), levels of the lipid oxidation marker, malondialdehyde (MDA), and the proinflammatory chemokine, monocyte chemoattractant protein-1 (MCP-1,) were found in those who reduced their BMI. In contrast, participants who did not improve their BMI exhibited higher levels of proinflammatory markers such as MCP-1 and tumour necrosis factor α (TNFα), as well as increased activity of the antioxidant enzyme catalase (CAT). Current findings suggest that an effective way to reduce BMI is a hypocaloric MedDiet combined with tailored physical activity to improve oxidative stress and proinflammatory status, and potentially reducing the risk of CVD.

Serum γ-glutamyltransferase levels and obesity status changes the risk of prehypertension in Chinese adults

Objective

It's well known that γ-Glutamyltransferase (γ-GGT) and obesity plays an important role in the development of preHT. However, the effect of γ-GGT on preHT in populations with different obesity status remains unclear.

Methods

From February 2014 to January 2018, a total of 20,368 participants were enrolled in this study after excluding those with hypertension and liver diseases. Fasting blood samples were collected to measure γ-GGT and blood lipid levels and glucose indices. Demographic and clinical parameters such as sex, age, height, weight, neck circumference (NC), waist circumference (WC), hip circumference (HC), and body fat ratio (BFR); and information on smoking and alcohol consumption were collected by trained medical professionals.

Results

Participants were divided into three groups based on obesity status. The prevalence of preHT was 83.5 % in the obesity group was higher than that in the overweight group (58.9 %) and the normal group (47.1 %). γ-GGT in different categories of obesity indices were significantly different, and higher obesity indices were found with higher γ-GGT levels. The interaction of γ-GGT and obesity indices such as NC, WC, HC, and BFR on the prevalence of preHT was significant (P = 0.028, 0.002, 0.007, and 0.034, respectively). Serum γ-GGT was found to be positively associated with preHT in participants with normal and overweight body mass indices.

Conclusion

Our results indicate that γ-GGT is a risk factor for preHT in participants who are nonobese, and that the obesity indices NC, WC, HC, BFR, and γ-GGT were contributing factors in increasing the risk of preHT.