The weight loss maintenance (wlm) trial randomized adults (n = 741) with hypertension (HTN) and/or dyslipidemia — but without evidence of cardiovascular disease — to one of several weight loss management programs. Although the initial outcome reports from WLM addressed the relative efficacies of different weight loss strategies over time, this report stratified study participants into those who lost, maintained, or gained weight over the 5-year study period. Tyson et al compared blood pressure effects between the three categories of weight impact, irrespective of which particular method of weight loss had been applied.

At study end, the weight-stable group had gained 0.6 kg, as compared with a 9.1 kg increase in the weight-gain group, and a 7.1 kg decrease in the weight-loss group. The weight-stable and the weightgain groups were noted to have similar increases in systolic blood pressure (SBP) over 5 years (SBP increase mean 4.2 mmHg), whereas the weight-loss group SBP was not statistically significantly changed.

In contrast to some other trials that report a “legacy effect” (prolonged beneficial impact of early intervention, even after the intervention has ceased), initial weight loss in WLM was not associated with favorable SBP effects if weight was regained. On the other hand, sustained modest weight reduction (< 10% of baseline BMI) had a sustained effect to maintain SBP. Although simply maintaining weight over the long term might appear to be a laudable goal, it is apparently insufficient to favorably affect SBP.