Rationale: Seven RCTs testing the effects of weight loss on blood pressure in overweight and obese individuals also had measures of cardiores-
piratory fitness, as measured by maximal oxygen uptake 346, 363, 369, 375, 377, 380; or submaximal heart rate tests. 365 Weight loss was accompanied by increased fitness, primarily if the intervention included increased physical activity or physical activity combined with diet. 346, 363, 375, 377, 380 These studies were not designed to test whether increased cardiorespiratory fitness reduces blood pressure independent of weight loss in overweight and obese adults. By contrast, in 3 meta-analyses of 68 controlled studies of physical activity conducted in normotensive and hypertensive individuals, obesity was not an outcome measure nor was it included in the eligibility criteria. These meta-analyses showed that aerobic exercise to increase cardiorespiratory fitness significantly reduces blood pressure independent of or in the absence of weight loss. 396-398
RECOMMENDATION: Weight loss is recommended to lower elevated blood pressure in overweight and obese persons with high blood pressure. Evidence Category A.
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