Effect of sleeve gastrectomy on hypertension

Highlights

• Laparoscopic sleeve gastrectomy results in a rapid and sustained decline in systolic blood pressure.

• There is a temporal dissociation between the decline in systolic blood pressure and body mass index.

• The decline in systolic blood pressure is associated with a major reduction in antihypertensive therapy.

Abstract

The objective of this study was to determine the effect of laparoscopic sleeve gastrectomy (LSG) on blood pressure in private practice settings. This study involved a retrospective review of 870 consecutive adult patients >18 y of age who underwent LSG over a period of 12 mo in a private bariatric surgery center. Data were collected from the preoperative and postoperative follow-up visits at 1, 3, 6, and 12 mo. The study population consists of 694 hypertensive and 176 normotensive patients. From the baseline to 12 mo after LSG, (1) mean body weight/body mass index decreased from 123 kg/44 kg/m² to 94 kg/34 kg/m² (P < .001); (2) mean systolic/diastolic blood pressure in hypertensive patients decreased from 131.9/79.9 to 127.6/77.1 mm Hg (P < .001); 3) only mean systolic blood pressure decreased in normotensive patients from 117.5 to 114.0 mm Hg (P < .001). One month after LSG, mean systolic blood pressure had decreased from 131.9 to 126.2 mm Hg (P < 0. 001) and the average number of antihypertensive medications per patient declined from 1.5 at the baseline to 0.6 (P < .001). Over the following 11 mo, blood pressure remained stable despite reduced antihypertensive therapy. Patients requiring more than two antihypertensive agents fell from 49% at the baseline to 22% at 12 mo. Hypertension resolved in 34% of patients. Linear regression analysis showed no association between change in body weight and change in systolic blood pressure. Within 1 mo of LSG, hypertensive patients experienced a significant decline in systolic blood pressure and antihypertensive therapy that remains unchanged at 12 mo in the face of major reductions in antihypertensive medications. Weight loss and blood pressure reduction may not be directly related.

Introduction

The benefits of bariatric surgery are well recognized in morbidly obese patients.1, 2, 3, 4, 5, 6 Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are currently the most commonly performed bariatric procedures. They result in similar weight loss and remission of type 2 diabetes mellitus (T2DM).2, 7 However, their effects on blood pressure (BP) appear to differ.⁸ LRYGB consistently lowers BP and lessens the requirement for antihypertensive therapy in obese patients with hypertension (HTN).1, 9 In contrast to LRYGB, LSG does not reliably lower BP in obese patients with HTN. While near complete resolution of HTN has been reported after LSG, others have failed to observe any effect of LSG on BP and antihypertensive therapy.10, 11 Because LSG has an inconsistent antihypertensive effect, obese patients with HTN may prefer to undergo LRYGB when considering bariatric surgery. To delineate the effects of LSG on BP, we retrospectively analyzed serial office BP measurements in a large and homogenous cohort of self-paying obese patients who underwent LSG in a private bariatric surgery center. Most of the patients included in the study elected to undergo LSG for cosmetic reasons, not for health promotion or disease prevention.