Study On The Effect Of Weight Management On Metabolic Improvement And Drug Reduction In Young And Middle-aged Patients With Obesity-related Hypertension

Objective:To explore the improvement in weight,blood pressure,metabolic indices and reduction in the dose and type of antihypertensive drugs used in young and middle-aged patients aged18-65 years with obesity-associated hypertension after a 3-month weight management.Methods:Patients aged 18-65 years who attended the cardiovascular medicine outpatient clinic of Shanxi Provincial People’s Hospital from May 2022 to August 2022 and met the diagnostic criteria for obesity-associated hypertension were selected for this study,and their general information,smoking and alcohol consumption,diet and exercise,and antihypertensive drugs using a descriptive questionnaire.Patients who agreed to participate in this study and had complete information on clinical metabolic indices,such as AST,ALT,FPG,UA,BUN,et al,were subjected to a 3-month weight management process that included health education,intensive management,personalized guidance,psychological counseling,and regular follow-up.The study subjects were divided into effective weight loss group and ineffective weight loss group by whether the weight loss was≥5%,and the changes in diet and exercise,physical and metabolic indices,and use of antihypertensive drugs were analyzed.Binary logistic regression analysis was used to explore the independent influencing factors of weight management on effective weight loss.Results:A total of 147 eligible young and middle-aged patients with obesity-associated hypertension were recruited for this study,and 139 questionnaires were returned,with a return rate of 94.5%.120 patients agreed to participate in this project and had complete information on clinical metabolic indices,48 patients were lost in follow-up due to epidemic closure,and 72 patients finally completed the study.The mean age of the patients was(48.6±12.1)years,63.3%were male,and the baseline BMI was[28.2(4.8)]kg/m~2,baseline waist circumference was[96.9(12.8)]cm,25.8%and 46.7%smokers and alcohol drinkers,respectively,79.2%of patients were nutritionally at risk,and53.3%were assessed as physically active inadequate.Taking single class antihypertensive drug(45.8%),two classes of antihypertensive drugs(37.5%),and three classes of antihypertensive drugs(10.0%),CCB(calcium channel blocker)was used most frequently(36.4%).The 72 patients who finally completed their study showed a significant improvement in metabolic indices,diet and exercise profiles after 3-months weight management(p<0.05).There was a general downward trend in the percentage of antihypertensive drug combinations and the total number of types,with no statistically significant differences(P>0.05).Grouped by whether the weight loss was≥5%of baseline,the mean weight loss was(9.0±2.6)%in the effective weight loss group(34.7%)and(0.7±3.1)%in the ineffective weight loss group(65.3%);WC,SBP,DBP,SCr,and TC values decreased from baseline and HDL-C increased from baseline in both groups,with statistically significant differences(P<0.05).The results of Kendall’s Tau-b correlation analysis showed that the effectiveness of weight loss was positively correlated with punch card compliance(r=0.281),baseline physical activity(r=0.383),literacy(r=0.342),and income status(r=0.326)and negatively correlated with age(r=-0.293),p<0.05.Binary logistic regression analysis showed that after correcting for gender,age,and education,patients with good punch card compliance(OR=4.771,95%CI:1.168～19.491,P=0.030)were more likely to have successful weight loss.Conclusion:In this study,young and middle-aged patients with obesity-related hypertension were predominantly male,and most of them had dietary nutritional risks and physical deficiencies.Regarding the use of antihypertensive drugs,the largest number of patients took single class antihypertensive drugs,while CCB was the most frequently used antihypertensive drug.After a 3-month weight management,there was a trend of decreasing weight,blood pressure,metabolic indices and type of antihypertensive medication in the study subjects,and the effective weight loss rate was 34.7%.Meanwhile,positive improvement effects were achieved in dietary nutrition and physical strength assessment,and patients with good punch card compliance were more likely to have successful weight loss.In the future,weight management plans should be proposed for a wider range of patients with obesity-related hypertension based on data from subsequent large-scale,long-term studies,with a view to more scientific weight reduction and blood pressure lowering and improved quality of life.