Some people take blood pressure medication, which could be affecting their weight. At first, it seems like water weight. Some medications cause water retention, while others slow your metabolism and lead to fat gain over time.
This can be frustrating, especially when you’re doing your best to stay healthy. The wrong treatment can make it harder to manage both your weight and your blood pressure.
Certain medications may support weight loss, while others are more neutral.
| 🔑 Key Takeaways ➤ Blood pressure medication can affect your weight, but it depends on the type. Some cause real fat gain, while others only lead to water weight changes. ➤ Beta blockers like atenolol, metoprolol, and propranolol are the most likely to cause real weight gain. They slow your metabolism and lower daily movement. ➤ On the other hand, ACE inhibitors like enalapril and ARBs like telmisartan may help with weight loss by burning fat and preventing new fat buildup. ➤ Some medications don’t usually affect your weight, like prazosin, olmesartan, and aliskiren. Others, like perindopril, may cause weight gain or loss depending on how your body reacts. ➤ If your medication are making you gain weight, don’t stop on your own. Talk to your doctor so they can adjust your treatment safely. ➤ You can manage weight gain by improving your sleep, eating more protein, staying active, and lowering your sodium if water retention is an issue. ➤ Exercise helps lower total fat, including the harmful kind around your belly. Aim for at least 150 minutes a week. |
How Blood Pressure Medication Affects Weight
Certain blood pressure medications can change your body weight, but the effect depends on the drug class. Some cause fluid shifts, while others lead to real fat gain.
According to a study, calcium channel blockers often cause peripheral edema, or water retention in tissues. This may make you heavier on the scale, but it’s not true fat gain. Meanwhile, thiazide diuretics and ACE inhibitors may lead to a short-term weight loss of about 1–2 kg during the first 6–8 weeks, mostly from water and salt loss.
In contrast, beta blockers (like propranolol, atenolol, and metoprolol) are consistently linked to real weight gain. The UKPDS study showed that atenolol users gained 3.4 kg, while those on captopril gained only 1.6 kg over 9 years, an increase of 1.8 kg for beta blocker users. In the Beta Blocker Heart Attack Trial, propranolol users gained 2.3 kg, compared to 1.2 kg in the placebo group. This 1.1 kg net gain lasted for 3 years and was not tied to age, sex, or physical activity.
The causes of weight gain are partly due to reduced basal metabolic rate, lower thermogenic response after meals, insulin resistance, and decreased lipolysis. Beta blockers also make you feel more tired, reducing physical activity and non-exercise thermogenesis, the calories you burn doing random small movements.
More evidence explains that chronic beta-blocker use reduces total energy expenditure (EE) and increases fat storage. Their study showed that EE, fat oxidation, and daily activity levels dropped by 30% to 50% in beta blocker users compared to non-users. Weight differences were striking. In one trial, beta blocker users weighed 5.2 kg more than non-users.
| 💡 Fun Fact Losing weight can lower blood pressure, with studies showing about a 1 mm Hg drop for every 1 kg lost, while gaining weight does the opposite, often raising blood pressure and increasing the need for medication. Managing your weight can directly affect how much blood pressure medicine you need. |
Drug Classes and Their Weight Effects
| Weight Effect | Drugs |
| Weight Gain | Atenolol, Metoprolol, Propranolol, Clonidine, Valsartan, Diltiazem |
| Possible Weight Gain | Acebutolol, Nadolol, Bisoprolol, Nebivolol |
| Weight Loss | Enalapril, Lisinopril, Ramipril, Telmisartan, Losartan, Irbesartan, Timolol, Chlorthalidone, Furosemide, Hydrochlorothiazide, Indapamide |
| Weight Neutral | Prazosin, Irbesartan, Olmesartan, Acebutolol, Aliskiren |
| Variable Effect | Perindopril |
If you’re taking medication for high blood pressure, it helps to know which drug class it belongs to. Blood pressure medication weight gain changes vary by type. Some are more likely to cause weight gain, while others may support weight loss or have no effect at all.
Drugs Linked to Weight Gain
Beta blockers are the most consistent in causing weight gain. According to a review, the following have consistently shown associations with weight gain:
- Atenolol
- Metoprolol
- Propranolol
These drugs slow your metabolism and make you feel more tired, which lowers your daily movement and fat burning.
Other beta blockers may also lead to weight gain, depending on the dose and duration, they are as follows:
- Acebutolol
- Nadolol
- Bisoprolol
- Nebivolol
Some other medications also show weight-gain potential. These include:
- Clonidine (an alpha-agonist)
- Valsartan (an angiotensin receptor blocker)
- Diltiazem (a calcium channel blocker)
- Perindopril (an ACE inhibitor)
Perindopril is unique, though. Some people gain weight on it, while others lose, depending on individual response.
Drugs That May Reduce Weight
Certain blood pressure medications may support weight loss, especially in specific conditions. Enalapril, an ACE inhibitor, was tested in animal studies. Long-term use led to reduced food intake and slower weight gain. It also increased fat-burning activity in adipose tissue. These changes were linked to better weight control, even with a high-fat diet.
ARBs like telmisartan also show promise. Telmisartan activates PPAR-delta in fat and muscle tissue. This speeds up fat breakdown and energy use. It also prevents new fat storage.
In a study, animals taking telmisartan had lower body weight and less visceral fat, even when on a high-fat diet. However, these effects disappeared in PPAR-delta knockout mice, showing how the drug’s action depends on this pathway.
Losartan and irbesartan, other ARBs, have also shown some weight-reducing effects, though not as strongly as telmisartan.
Weight-Neutral and Loss-Associated Options
Some medications are considered weight-neutral, meaning they usually don’t cause weight gain or loss. These include:
- Prazosin
- Irbesartan
- Olmesartan
- Acebutolol
- Aliskiren
Other drugs are more often linked to weight loss. These include:
- Enalapril
- Lisinopril
- Ramipril
- Losartan
- Telmisartan
- Timolol
- Chlorthalidone
- Furosemide
- Hydrochlorothiazide
- Indapamide
Keep in mind that individual response varies. Perindopril, for example, shows both gain and loss across studies. That’s why your doctor might adjust your treatment plan based on how your body reacts.
What to Do If Your Medication Makes You Gain Weight
Blood pressure medication weight gain changes can be frustrating, especially when you’re trying to stay healthy. But there are safe and effective steps you can take to manage your weight without stopping your treatment.
- Talk to Your Doctor First
If your blood pressure medication is making you gain weight, you shouldn’t stop taking it abruptly. The first and most important step is to talk to your doctor.
Stopping the medication on your own can worsen your condition or trigger severe side effects. Your doctor might adjust the dose or switch you to a different drug that is less likely to affect your weight.
- Start with Key Lifestyle Changes
Beyond switching medications, lifestyle changes play a key role in managing this side effect.
For example, sleeping 7 to 9 hours per night and aiming for at least 150 minutes of physical activity per week. These changes help regulate your metabolism and reduce fat accumulation.
You can also limit alcohol, avoid smoking, and eat a diet rich in fruits, vegetables, and whole foods to further support your weight management goals.
- Control Fluid Retention and Sodium
If fluid retention is the cause, especially with calcium channel blockers or vasodilators, reducing sodium intake can help.
A potassium-rich diet may also support sodium balance, since potassium helps flush out excess sodium.
According to the World Health Organization, daily sodium intake should stay below 2,000 mg.
High-potassium foods include:
- Bananas
- Spinach
- Coconut water
- Black beans
- Avocados
- Edamame
- Beets
- Sweet potatoes
- Manage Hunger and Meal Timing
Meal frequency and portion control can reduce appetite spikes. Eating six small meals a day instead of three large ones may help if your medication increases hunger. A diet high in protein may also keep you full longer. A review found that protein-rich diets (18–59% of energy intake) improved weight control.
- Exercise to Reduce Fat Accumulation
Exercise is another effective strategy. One study found that exercise can lower:
- Body weight
- Total body fat
- Visceral fat, the fat stored around internal organs in the abdomen.
- Consider Intermittent Fasting Carefully
You may also consider intermittent fasting if your doctor agrees. This strategy involves eating within specific windows of time.
According to a review, intermittent fasting helped many people lose weight, but it isn’t for everyone, so it requires medical guidance.
Wrap Up
Blood pressure medications can lead to weight gain or loss, depending on the drug. Some, like beta blockers, often cause real weight gain by slowing your metabolism and lowering your daily energy use. Others, such as ACE inhibitors or certain ARBs, may support modest weight loss or have no effect at all.
Not everyone reacts the same way. That’s why it’s important to monitor changes and talk to your doctor if your weight shifts.
Frequently Asked Questions
Is the weight gain permanent?
Not always. If it’s from water, it can drop fast with lifestyle changes or a new med. Fat gain takes longer to lose but can be reversed.
How much weight do I need to lose to see a change in my blood pressure?
Just 5 pounds (about 2.3 kg) can help. The more weight you lose, the more your blood pressure may drop.
Is high blood pressure a lifelong condition?
Yes, usually. Even if you stop meds, you’ll still need to manage your blood pressure every day with healthy habits.
Can drinking alcohol affect my blood pressure meds?
Yes. Alcohol can raise your blood pressure and make meds less effective. It’s best to limit or avoid it.
Sources
- Mosenkis, A., & Townsend, R. R. (2004). Antihypertensive medications and weight gain. Journal of clinical hypertension (Greenwich, Conn.), 6(2), 90. https://doi.org/10.1111/j.1524-6175.2004.02847.x
- Lee, P., Kengne, A.-P., Greenfield, J. R., Day, R. O., Chalmers, J., & Ho, K. K. Y. (2011). Metabolic sequelae of β-blocker therapy: Weighing in on the obesity epidemic? International Journal of Obesity, 35, 1395–1403. https://doi.org/10.1038/ijo.2010.284
- Harsha, D. W., & Bray, G. A. (2008). Weight loss and blood pressure control (Pro). Hypertension, 51(6), e36–e38. https://doi.org/10.1161/HYPERTENSIONAHA.107.094011
- Wharton, S., Raiber, L., Serodio, K. J., Lee, J., & Christensen, R. A. (2018). Medications that cause weight gain and alternatives in Canada: a narrative review. Diabetes, metabolic syndrome and obesity : targets and therapy, 11, 427–438. https://doi.org/10.2147/DMSO.S171365
- Santos, E. L., de Picoli Souza, K., da Silva, E. D., Batista, E. C., Martins, P. J. F., D’Almeida, V., & Pesquero, J. B. (2009). Long term treatment with ACE inhibitor enalapril decreases body weight gain and increases life span in rats. Biochemical Pharmacology, 78(8), 951–958. https://doi.org/10.1016/j.bcp.2009.06.018
- Vasim, I., Majeed, C. N., & DeBoer, M. D. (2022). Intermittent Fasting and Metabolic Health. Nutrients, 14(3), 631. https://doi.org/10.3390/nu14030631