michigan hypertension core curriculum - State of Michigan

foods and turn out of necessity to calorie-rich but nutritionally poor foods. Second, the poor tend to
have lower education levels and less access to medical care, further increasing the risk for obesity
and HTN. In addition, such individuals may be less likely to have their HTN diagnosed and even after
diagnosis, may be less able to afford the recommended treatments.
Obesity is particularly relevant because it adds to and exacerbates the co-morbidities often
seen in individuals presenting for medical care. Obesity can not only contribute to HTN, DM and
hyperlipidemia, but also makes such diseases harder to control. In the treatment of HTN in obese
individuals, weight management needs to be a central focus of the overall treatment plan. 14 Weight loss
can result decreases in BP similar to what can be realized with most medications. Not only has obesity
been linked to an increased risk for developing hypertension, it is also a marker for pharmacological
treatment resistance. In addition, aerobic activity done as part of weight loss can further decrease
BP. For example, regular walking has been shown to attenuate weight gain associated with
age. 15 Instruction on low sodium diets (such as the DASH diet) can also play a positive role in HTN
management. As up to half of patients being treated report that their provider has not discussed their
weight with them, it is incumbent on all providers to elevate weight control and weight reduction to the
same status reserved for discussions of DM. HTN and other medical disease.
Patients should be reminded that becoming overweight or obese typically has taken years if
not decades. As such, lifestyle modifications designed to promote weight loss will also take weeks
to months before significant weight loss may be realized. At the same time, patients may feel
symptomatically improved with modest weight loss. The promotion of lifestyle modifications should
proceed in parallel with pharmacologic treatment. The first priority of HTN management is control
of the blood pressure. Medications can always be withdrawn as patients make the lifestyle changes
necessary to reduce their tendency towards HTN. Often, encouraging patients with the possibility of
freedom from some of all of their anti-hypertensive medications if they adjust their diet and exercise
regimens can be a potent inducement for action. Obesity is a significant but manageable contributor to
HTN and CV disease overall and must be approached on multiple fronts simultaneously for maximum
effect.
Figures:
1. Graph showing prevalence of obesity in the U.S., NHANES
2. Graphic showing risk of CVD associated with obesity
66 Hypertension Core Curriculum