Early Hypertensive Screening in Patients with Obesity: Expert Perspective
Obesity medicine expert Caissa Troutman, MD, suggests using annual physicals as a "gateway" to identify patients with obesity with elevated blood pressure.
For individuals with obesity or overweight, screening for hypertension should begin early, even in childhood, obesity medicine expert Caissa Troutman, MD, told Patient Care Online in a recent interview. In the video above, Troutman discusses the importance of early hypertension screening in patients with overweight or obesity, emphasizing its role in preventing cardiovascular-kidney-metabolic (CKM) syndrome. She also offers practical guidance on incorporating regular blood pressure screenings and nonpharmacologic interventions into patient care.
The following transcript has been edited for clarity.
Patient Care: How early should hypertensive screening be done in patients with overweight or obesity?
Caissa Troutman, MD: Screening should begin early, even in childhood. We’ve seen that children with obesity often have elevated blood pressure. This ties into what we now call cardiovascular-kidney-metabolic (CKM) syndrome, a more comprehensive way to view metabolic syndrome. As we learn more about how our hormones and organ systems are interconnected, CKM syndrome encompasses obesity, diabetes, chronic kidney disease, and cardiovascular disease.
Excess weight is actually the first stage of CKM syndrome. Stage 0, I believe, is characterized by excess weight, and stage 1 involves excess adipose tissue. These are early warning signs, so it’s crucial to monitor and track these patients closely.
Patient Care: How should these individuals be screened more frequently?
Troutman: The annual physical is an excellent opportunity to initiate screening. Following current guidelines, if a patient’s blood pressure falls into the elevated range—120 to 129 mmHg—they should be counseled on non-pharmacologic interventions to lower blood pressure, and reassessed in three to six months.
The challenge often lies in maintaining follow-up—whether through appointment availability or patient compliance. It’s critical to individualize care, have ongoing discussions about progress, and explore additional support options if needed. Regular reassessment and tailored interventions can make a significant difference in managing these patients effectively.
