If you’re navigating life with resistant hypertension (high blood pressure that doesn’t improve with multiple treatments), you may have heard that losing weight can make a difference. Can weight loss improve your blood pressure more effectively than antihypertensives (medications that aim to lower blood pressure)?

Turns out, even modest weight loss can have more of an impact than you might expect. According to the American Heart Association, losing as little as 10 pounds may help you maintain a healthy blood pressure range.

The connection between your weight and your blood pressure is complex, and other conditions (like sleep apnea or diabetes) may play a role. Here, we talk about some of the ways losing weight can lower your blood pressure.

How Weight Loss Helps Lower Blood Pressure

Losing weight can help lower blood pressure, among other cardiovascular health benefits. In some cases, it can also improve control in resistant hypertension.

Often, if you have high blood pressure, lifestyle changes for weight management are among your healthcare provider’s first suggestions. They may also prescribe antihypertensives like calcium channel blockers or diuretics.

In one study that evaluated the effect of weight loss on people with hypertension, participants experienced a weight reduction of about 10 percent of their body weight. Their systolic and diastolic blood pressure dropped by 4.3 millimeters of mercury (mm Hg) and 3.8 mm Hg on average after four years.

In a similar study, participants’ systolic and diastolic blood pressure dropped by an average of 6.6 mm Hg and 3.6 mm Hg after reducing their body mass index (BMI) score between 4 and 5 points.

If you don’t have high blood pressure but are at risk, keeping a healthy weight can help you prevent it and any associated heart complications.

Lowering Blood Volume

With a higher body weight, your body needs more blood to supply your organs and tissues with the oxygen and nutrients they need. Your heart must work harder to pump this blood, which can contribute to increased blood pressure.

Your blood volume and blood pressure are connected through the renin-angiotensin-aldosterone system (RAAS). This system regulates your blood pressure and volume by increasing your sodium and fluid levels. When you lose weight, you also lose blood volume, and your blood pressure tends to decrease.

Reducing Sympathetic Nervous System Activity

Your sympathetic nervous system is the part of your nervous system that automatically activates when you’re stressed, exercising, or in danger. It causes a range of changes in your body, including an increased heart rate, widened pupils, and increased blood pressure. All of these symptoms coordinate to help you stay alert and prepared to face immediate challenges.

In people living with obesity, the sympathetic nervous system is often activated even when there’s no stress or danger. This constant activation is driven in part by the hormone insulin and a chemical in your body called leptin.

An overexcited sympathetic nervous system contributes to high blood pressure. Losing weight may reduce sympathetic nervous system activity and therefore help lower blood pressure.

Improving Insulin Sensitivity

High insulin levels contribute to a highly active sympathetic nervous system. High insulin levels are seen in people with insulin resistance, a condition that makes it harder for your body to use insulin to move blood glucose (sugar) into cells, where it can be used for energy.

Insulin resistance affects around 70 percent of people with obesity and can make it harder to lose weight.

Losing weight can improve insulin sensitivity, which means your cells are more receptive to insulin. This can lead to lower blood pressure, lower blood sugar, and lower cholesterol.

Lowering Inflammation

Higher body weight can come with low-grade chronic inflammation, which can affect blood vessel function and contribute to high blood pressure. Weight loss can help control this inflammation and restore typical blood vessel function, leading to lower blood pressure.

Other Possible Improvements

As you go through the process of losing weight, a few other changes may also help manage blood pressure. One such change is reduced sodium sensitivity, or less sensitivity to salt.

Everyone’s blood pressure can fluctuate based on their salt intake, but if you’re salt sensitive, your blood pressure increases more than the average when you consume sodium. When your body is more salt sensitive, it retains more water. This leads to a higher blood volume and blood pressure.

Salt sensitivity is also linked to a more active sympathetic nervous system.

Another factor of weight loss that may improve high blood pressure is a possible improvement in sleep apnea. Obstructive sleep apnea (OSA) is closely linked with obesity and is characterized by a collapsing airway when you sleep. This causes you to repeatedly stop breathing, which prevents restful sleep and impacts your cardiovascular function.

OSA also triggers your sympathetic nervous system, leading to spikes in blood pressure. Weight loss can reduce pressure on your airway at night, improving OSA in some cases and helping lower blood pressure. You may still need to take medications or undergo continuous positive airway pressure (CPAP) therapy to manage your OSA if it persists.

Resistant Hypertension and Weight Loss

Resistant hypertension is high blood pressure that doesn’t get better with aggressive treatment. Specifically, this involves taking three or more antihypertensive medications for at least six months without improvement.

Closely linked with OSA, physical inactivity, a high salt intake, kidney disease, and obesity, resistant hypertension may improve with weight management strategies like physical activity and balanced eating.

If you lose weight and your resistant hypertension improves, you may be able to reduce the number of antihypertensives you take or taper off of them entirely. Always check with your doctor before you stop taking medications or reduce their dose, even if you’ve lost significant weight.

Talk to Your Doctor

If you live with obesity and hypertension, talk to your doctor about strategies you can follow to safely lower your blood pressure. Your doctor may prescribe antihypertensives and can tell you how and when to take them. Even if you’re making lots of lifestyle changes to improve your blood pressure, you may still need to take medications for some time.

Your healthcare provider can recommend lifestyle changes to help with blood pressure while also improving related conditions such as sleep apnea, insulin sensitivity, and hypertension. They might suggest strategies like:

• Balancing your diet
• Managing other health conditions that influence body weight and blood pressure
• Increasing your physical activity

The American Heart Association recommends at least 150 minutes of moderate intensity exercise per week.

Lowering your blood pressure with these strategies can improve your overall cardiovascular health. By safely reducing your blood pressure, you can lower your risk of cardiovascular disease, heart attack, stroke, and other life-threatening health problems.

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On MyObesityTeam, people share their experiences with obesity, get advice, and find support from others who understand.

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