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Effect of weight loss on abnormal 24-hour blood pressure patterns in severely obese patients

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Abstract

Background

Nocturnal hypertension (night systolic [S]/diastolic [D] blood pressure [BP]≥120/70 mm Hg), nondipper status (nocturnal BP fall<10% of daytime values), and pulse pressure ([PP]; difference between 24-h SBP and DBP readings) are associated with increased risk of cardiovascular disease. We evaluated the 1-year effect of significant surgical weight loss (WL) on abnormal BP patterns in patients with and without hypertension and identified the factors involved.

Setting

University hospital, Spain.

Methods

This prospective study included 42 patients (28 normotensive [NT] and 14 hypertensive [HT]), 71% women with a mean age (standard deviation [SD]) of 48 (11) years undergoing bariatric surgery (BS): 22 laparoscopy Roux-en-Y gastric bypass (LRYGB) and 20 sleeve gastrectomy (SG). SG: 20. Before and 12 months post-BS, anthropometric data, BP (24-h ambulatory BP measurement), and metabolic parameters were determined. At 12 months post-BS ultrasonographic carotid assessment was performed in a subgroup of patients (22).

Results

Both groups experienced significant WL (percent of excess body weight loss [%EBWL] 68%), a fall in 24-h SBP of−13 (11)/DBP−3 (7) mm Hg, and improvement in all the metabolic parameters evaluated and the homeostatic model assessment of insulin resistance (HOMA-IR). However, nondipper status remained high in NT (54%) and HT (64%) as well as 60% of the patients with carotid plaque. Additionally, in HT patients nocturnal hypertension and PP remained significantly higher, and basal fasting insulin values and the HOMA-IR score were significantly higher in those not normalizing dipper status.

Conclusion

Surgery-induced WL was associated with a sizeable decline in BP and metabolic parameters improvement. However, independent of the presence of hypertension, the prevalence of abnormal 24-h BP patterns remained high, and thus, cardiovascular risk continued to be high in these patients.

Section snippets

Methods

The study group included 42 severely obese patients (normotensive = 28 and hypertensive = 14) with nondipper status in whom BS (laparoscopic Roux-en-Y gastric bypass [LRYGB) or sleeve gastrectomy [SG]) was performed from 2012 to 2013 in a tertiary hospital. Impaired BP rhythm was established by ABPM performed during the preoperative evaluation. In hypertensive patients the ABPM was performed without antihypertensive medication for 1 week. In addition to nondipper status, the following inclusion

Results

Our study included patients undergoing bariatric surgery between 2012 and 2013, and during this period of time we performed ABPM for study purposes. Of the 119 patients who accepted to participate in the study, 82 were normotensive; of these, 49 had nondipper status, and in 28 we had a valid ABPM at 12 months after BS. In addition, 37 were hypertensive, 18 of whom had nondipper status and 14 had valid ABPM at 12 months after BS.

Of the 42 obese patients, 28 (67%) had normotension and 14 had HT

Discussion

The objective of this study was to evaluate the effects of surgically induced weight loss on abnormal 24-hour BP patterns in severely obese patients 1 year after BS regardless of the presence of HT. This study indicates that the percentage of nondipping patterns remained significantly high in both groups of patients despite significant weight loss, a sizeable fall in BP, and a significant improvement in metabolic and inflammatory parameters and HOMA-IR. In addition, the prevalence of nocturnal

Conclusion

Our findings have important clinical implications because BP levels decrease and antihypertensive treatment is frequently stopped after BS. These findings suggest that therapeutic BP interventions may be required to normalize BP patterns to provide greater protection against target-organ damage, because the impact of the reduced nocturnal fall in BP on atherosclerosis in nondippers is probably independent of the overall BP load and is more likely related to a lack of nocturnal fall. Indeed, it

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    Obesity, inter alia due to increase in sympathetic activity was related to high BPV in spectral analysis [16], visit-to visit BPV [18] and to increased standard deviation (SD) index of ambulatory blood pressure monitoring (ABPM) readings [19–21]. To the best of our knowledge, little is known about the alterations of the BPV among extremely obese patients after bariatric surgery [22–24]. What is more, no study assessed the profile and blood pressure variability (BPV) in a short period after bariatric surgery.

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