Body weight reduction necessary to attain normotension in the overweight hypertensive patient.

All 212 patients with essential hypertension and an overweight of at least 10 per cent in excess of ideal body weight, referred to out clinic in the years 1975-1979, were included in this study. The patients were advised to take a balanced low-calorie (about 1080 kcal/day) diet containing 83 g carbohydrates, 41.5 g fat and 85 g proteins. They were advised to eat salt freely. There were 40 patients who had four clinic visits or less and 49 others who could not follow their diet. Therefore the compliance-failure rate was 89/212, ie 42 per cent. Decrease in body weight resulted in a significant decrease in blood pressure, despite free ingestion of salt and with 24-h urine sodium which was not different from that obtained before dietary therapy was started. Over two-thirds of the compliant patients will achieve normal blood pressure with a loss of only one-half of their weight excess, even if at this point they are still overweight. In the group receiving no diuretic or any other anti-hypertensive therapy, 82.6 percent reached normal systolic blood pressures and 78.3 per cent reached normal diastolic blood pressures, but only 31/38 reached a body weight within 10 per cent of ideal body weight. It is concluded that most of overweight hypertensive patients can attain a normal blood pressure by reducing body weight, long before achieving the ideal weight.