[Health Channel/Comprehensive Report] A man in his 50s lost weight through slimming injections, but fell down when he stood up. Ling Luojie, the attending physician at the Department of Cardiology and Cardiac Electrophysiology at Shin Kong Wu Huo Shi Memorial Hospital, cited a case: A man in his fifties took medication for high blood pressure for three years, and his blood pressure remained around 140.
A year ago, he made up his mind to lose weight and used GLP-1 receptor agonists (commonly known as slimming injections) in the outpatient clinic together with diet and exercise. He lost 14 kilograms in half a year and no longer breathed when climbing stairs. Until one weekend morning, he stood up from the sofa, but his vision went completely white. He fell down and hit his forehead on the coffee table. His family called an ambulance. The blood pressure measured in the emergency department was 92/58 mm Hg, and the electrocardiogram and myocardial indicators were normal. The answer was in his medicine bag: two antihypertensive pills, the dosage was exactly the same as three years ago.
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Ling Luojie said bluntly that the patient's blood pressure had actually "become better", so much so that the original dosage of medication was too much for him now. One of the bonuses of successful weight loss is that antihypertensive drugs can be adjusted downward; however, the dosage should be adjusted by a physician.
If you lose weight, your blood pressure will also drop.
According to statistics from the National Health Service, the overweight and obesity rate among Chinese adults has reached 50.3%. With the popularity of weight-loss drugs, more and more people have actually lost weight, and a new problem has also appeared in cardiology departments.
Ling Luojie said, "There is a magnitude to how weight loss can lower blood pressure." A comprehensive analysis of 25 randomized trials involving nearly 4,900 people found that for every 1 kilogram lost, systolic blood pressure dropped by about 1 mmHg on average; for those who lost more than 5 kilograms, the average drop was 6.6 mmHg.
Trials of drug weight loss go in the same direction. An analysis that combined three trials of GLP-1 receptor agonists and included individual data from more than 3,000 people found that the systolic blood pressure dropped about 5 mmHg more in the drug group than in the placebo group, and about 89% of this was achieved through weight loss. Blood pressure will drop mainly because people really lose weight. Bariatric surgery is more straightforward: 83.7% of patients who originally took more than two antihypertensive drugs achieved "reducing antihypertensive drugs by more than 30% and still maintaining blood pressure within standard" one year after surgery, while only 12.8% of patients in the control group achieved this.
Ling Luojie emphasized, "After successful weight loss, the dosage of medicine must be recalculated. This is expected, not a guess." The dosage of medicine is prescribed according to the weight and vascular condition at that time. After losing 10% to 20% of the body weight, the body's demand for medicine decreases, but the dosage of medicine stays at the same level, which becomes a relative overdose. The first thing to reveal is often not the blood pressure measured while lying down, but the few seconds when you change positions: if the systolic blood pressure drops by more than 20 mmHg or the diastolic blood pressure drops by more than 10 mmHg within three minutes of standing up, it meets the definition of postural hypotension.
People who use this type of drug to lose weight also have additional benefits: reduced appetite leads to less eating and drinking, and a decrease in water and salt. Gastrointestinal side effects may also lead to dehydration. The drug itself also has the effects of promoting sodium excretion and relaxing blood vessels. The key point is that "after successful weight loss, the original chronic disease medication list must be recalibrated."
If these conditions occur, do not wait for the next follow-up visit
・My vision goes blank when changing positions: getting up, standing up after sitting for a long time, coming out of a hot bath, and having to shake a little before I can stand up.
・Systolic blood pressure value: When using a home blood pressure machine, systolic blood pressure often appears to be around 100, especially in the morning.
・Different living conditions: I feel like I haven’t fully recharged my batteries all day long, and I feel more tired when climbing stairs than before I lost weight.
・Those who are taking diuretics: decreased urine output, dry mouth, and calf cramps.
・If you have fallen or hit your head: seek medical attention directly.
Why should a doctor reduce medication?
Many people will think that it would be better if I took less blood pressure medication; Ling Luojie emphasized "No". Ling Luojie explained that physician-led medication reduction is safe and feasible, but it is a course of treatment that needs to be tracked. In a randomized trial of people over 80 years old taking two or more antihypertensive medications, who had their physicians drop one medication, 66.3% remained at their post-taper status after 12 weeks, with systolic blood pressure in the tapering group averaging 3.4 mm Hg higher. As the saying goes: two-thirds can be lost, and one-third must be added back with medicine. The difference lies in whether anyone is tracking. There are two other things that only doctors can tell:
1. Which one should be used first: When food intake and water intake are reduced, diuretics are usually the first to be tested, but the combination is different for each person.
2. Some drugs are not just for blood pressure: for patients after myocardial infarction, heart failure and some arrhythmias, beta blockers or vasoconstrictor inhibitors play a role in protecting the heart, and blood pressure cannot be stopped even if the blood pressure is high.
Three lessons during weight loss
1. Record blood pressure and weight together: According to the 722 principle (seven days in a row, once in the morning and evening, twice each time), the blood pressure at home should be taken back to the clinic together with the weight record.
2. For every 5 kilograms of weight loss, or if the weight loss exceeds 5% of the original weight, "whether the medicine is still suitable for you" should be included in the questions to be asked during the follow-up visit.
3. Return to the doctor early if you feel dizzy: Do not stop taking medicine on your own, and do not stop losing weight because you are afraid of dizziness.
