How does a low Body Mass Index (BMI) help with hypertension?

From the Guidelines

Maintaining a healthy BMI is crucial for managing hypertension, and weight loss in overweight or obese individuals can lower blood pressure by approximately 1 mmHg for every 1 kg of weight lost, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1. To achieve a healthy BMI, it is essential to adopt a balanced diet rich in whole grains, fruits, vegetables, polyunsaturated fats, and dairy products, while reducing sodium intake to less than 2,300 mg daily, as suggested by the guidelines 1. Some key points to consider when trying to lower BMI and manage hypertension include:

• Eating a diet that is rich in whole grains, fruits, vegetables, polyunsaturated fats, and dairy products, such as the DASH diet, which can help reduce blood pressure 1
• Reducing food high in sugar, saturated fat, and trans fats, such as fast foods and processed foods, which can increase blood pressure 1
• Increasing intake of vegetables high in nitrates, such as leafy vegetables and beetroot, which can help reduce blood pressure 1
• Drinking moderate amounts of coffee, green and black tea, and other beverages that can be beneficial, such as karkadé (hibiscus) tea, pomegranate juice, beetroot juice, and cocoa 1
• Limiting alcohol consumption to 2 standard drinks for men and 1.5 for women (10 g alcohol/standard drink) and avoiding binge drinking, as excessive alcohol consumption can increase blood pressure 1
• Engaging in regular physical activity, such as moderate-intensity aerobic exercise for 30 minutes on 5-7 days per week, or high-intensity interval training (HIIT), which can help reduce blood pressure 1
• Reducing stress and inducing mindfulness through practices such as transcendental meditation or mindfulness, which can help lower blood pressure 1 Weight loss should be gradual, aiming for 1-2 pounds per week through a daily caloric deficit of 500-1000 calories, and even modest weight loss of 5-10% of body weight can produce meaningful blood pressure improvements, often reducing the need for antihypertensive medications, as supported by the aha dietary guidelines: revision 2000 1. It is also important to note that reducing abdominal obesity is especially beneficial, as the fat around the organs (visceral fat) particularly impacts blood pressure, and achieving a waist-to-height ratio <0.5 is recommended for all populations, as suggested by the 2020 international society of hypertension global hypertension practice guidelines 1.

From the Research

Relationship Between Low BMI and Hypertension

• A low Body Mass Index (BMI) is associated with a lower risk of hypertension, as evidenced by studies that show a positive correlation between higher BMI and increased risk of hypertension 2.
• Maintaining a healthy BMI, along with other lifestyle factors such as a healthy diet, regular exercise, and limited alcohol consumption, can help lower systolic blood pressure and reduce the risk of cardiovascular disease (CVD) by about 30% 3, 4.
• Lifestyle interventions, including weight management and healthy dietary patterns, have been shown to be effective in preventing and treating hypertension, with regular physical exercise and body weight management being key components 5.

Mechanisms Behind the Positive Impacts of Low BMI on Hypertension

• The mechanisms behind the positive impacts of low BMI on hypertension may include the prevention of traditional risk factors such as obesity and insulin resistance, improvements in vascular health, and reduced sympathetic overactivation 5.
• A low BMI may also be associated with improved redox and inflammatory status, which can help reduce blood pressure and cardiovascular risk 5.
• Additionally, a low BMI may be linked to increased secretion of myokines, which can have beneficial effects on blood pressure and cardiovascular health 5.

Comparative Efficacy of Low BMI and Anti-Hypertensive Interventions

• While anti-hypertensive medications are often more effective than lifestyle interventions, including exercise and weight management, in reducing blood pressure, there is evidence to suggest that a low BMI can be an effective adjunct to medication in managing hypertension 6.
• A network meta-analysis of randomized controlled trials found that exercise interventions, which can help achieve and maintain a low BMI, had a significant effect on reducing blood pressure in people with hypertension, although the evidence base is limited compared to medication research 6.