Obesity management interventions delivered in primary care for patients with hypertension or cardiovascular disease

Obesity is associated with numerous co-morbidities, including cardiovascular disease (CVD), type 2 diabetes, hypertension, and certain cancers. The coexistence of hypertension and obesity greatly enhances cardiovascular risk, and if left untreated can increase the risk of coronary heart disease (CHD), stroke, heart failure, kidney failure, dementia, and other chronic diseases. Hypertension and other risk factors for CVD such as dyslipidemia, inflammatory markers, and impaired endothelial function appear to be associated with increases in adiposity and/or reductions in physical activity. The first-line strategy for the treatment of obesity and prevention of cardiometabolic disease is achieving weight loss. Lifestyle measures, which consist of reductions in caloric intake by between 500 to 1000 calories per day, together with increases in physical activity and changes in health behaviors, are the cornerstone of prevention and treatment of obesity. However, maintenance of behavioral changes associated with weight loss can be challenging and short-term improvements commonly fail to be translated into long-term behavioral maintenance. Therefore, adding anti-obesity drugs in obese patients who do not achieve sufficient weight loss or who find it difficult to maintain initial weight loss after lifestyle modifications may be a good strategy for patients who can safely use them. It has been shown in hypertension treatment trials that weight loss, whether alone or in combination with antihypertensive drugs, has a beneficial effect on blood pressure control and heart rate and may therefore have a role in the management of hypertension in overweight and obese patients. Research questions: 1. What is the clinical effectiveness of long-term primary care obesity management interventions in halting or slowing the progression of hypertension? 2. What is the clinical effectiveness of long-term primary care obesity management interventions in halting or slowing the progression of cardiovascular disease?