Hypertension Management in Patients with Obesity: 3 Pearls for Primary Care

Patient Care Online: What are 3 key takeaways from our discussion on obesity and hypertension that you feel are most important for our primary care audience?

Caissa Troutman, MD: First, start early when managing blood pressure. We often wait too long, but remember—130 is the new 140. If a patient is in the elevated blood pressure category, initiate lifestyle changes right away. In obesity medicine, we focus on 4 pillars: nutrition, physical activity, behavioral strategies, and medication. For blood pressure management, that could mean small, actionable steps like reducing processed food intake or adding a daily serving of leafy greens. Instead of handing patients generic advice, give them something practical and achievable—what I call “low-hanging fruit.” If a patient drinks 5 sodas a day, suggest cutting back to 4. Then, follow up in three to six months, not a year, to track progress and adjust as needed.

Second, treating obesity is essential for lowering blood pressure. If a patient has obesity, address it as a medical condition using the same four pillars. What’s one small nutrition change they can make? Can they add 10 minutes of walking to their day? Sleep, stress management, and medication all play a role. Medications can be key in supporting lifestyle changes, yet many patients tell me their providers dismiss weight loss medications while prescribing multiple medications for other conditions. If we recognize obesity as a disease, we must treat it as one—doing so often improves other health factors.

Third, maintain open, consistent, and nonjudgmental communication. Building patient trust takes time, sometimes several appointments, but staying patient and reinforcing the message makes a difference. I know this process can feel frustrating for providers, but consistency helps patients engage with their treatment and make meaningful progress.

For more of Patient Care's conversation with Dr Troutman, check out:
Understanding the Obesity-Hypertension Connection: A Clinician Discussion

Early Hypertensive Screening in Patients with Obesity: Expert Perspective

Managing Hypertension in Patients with Obesity: Clinician Strategies for Long-Term Care

Obesity and Hypertension: Addressing Misconceptions in Clinical Practice

Overcoming Barriers in Obesity and Hypertension Management: Practical Strategies for Physicians