Maria Careaga1, Enric Esmatjes2, Isabel Nuñez3, Judit Molero4, Josep Vidal5, Lilliam Flores6. 1. Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain. Electronic address: mccareag@clinic.ub.es. 2. CIBERDEM: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain. 3. Diagnostic Imaging Center, Hospital Clinic, Barcelona, Spain. 4. Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain. 5. Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain; CIBERDEM: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain. 6. Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain; CIBERDEM: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain.
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.
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 HTpatientsnocturnal 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.
Authors: Anna Oliveras; Albert Goday; Laia Sans; Carlos E Arias; Susana Vazquez; David Benaiges; José Manuel Ramon; Julio Pascual Journal: Obes Surg Date: 2020-01 Impact factor: 4.129