Effects of Bariatric Surgery Versus Medical Therapy on the 24-Hour Ambulatory Blood Pressure and the Prevalence of Resistant Hypertension

Abstract

Bariatric surgery is an effective strategy for blood pressure (BP) reduction, but most of the evidence relies on office BP measurements. In this study, we evaluated the impact of bariatric surgery on 24-hour BP profile, BP variability, and resistant hypertension prevalence. This is a randomized trial including obese patients with grade 1 and 2 using at least 2 antihypertensive drugs at maximal doses or >2 at moderate doses. Patients were allocated to either Roux-en-Y Gastric Bypass (RYGB) combined with medical therapy or medical therapy alone for 12 months. The primary outcome was the 24-hour BP profile and variability (average real variability of daytime and night time BP). We evaluated the nondipping status and prevalence of resistant hypertension as secondary end points. We included 100 patients (76% female, body mass index, 36.9±2.7 kg/m 2 ). The 24-hour BP profile (including nondipping status) was similar after 12 months, but the RYGB group required less antihypertensive classes as compared to the medical therapy alone (0 [0–1] versus 3 [2.5–4] classes; P <0.01). The average real variability of systolic nighttime BP was lower after RYGB as compared to medical therapy (between-group difference, −1.63; 95% CI, −2.91 to −0.36; P =0.01). Prevalence of resistant hypertension was similar at baseline (RYGB, 10% versus MT, 16%; P =0.38), but it was significantly lower in the RYGB at 12 months (0% versus 14.9%; P <0.001). In conclusion, RYGB significantly reduced antihypertensive medications while promoting similar 24-hour BP profile and nondipping status. Interestingly, bariatric surgery improved BP variability and may decrease the burden of resistant hypertension associated with obesity. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01784848.

Melanocortin-4 Receptors and Sympathetic Nervous System Activation in Hypertension

“…Unfortunately, lifestyle modifications have provided limited benefits to a significant portion of obese subjects at risk for developing hypertension and other cardiometabolic diseases. Therefore, pharmacological approaches and bariatric surgery continue to receive attention as a means to reduce the incidence of obesity and alleviate its cardiometabolic consequences [26]. Because of its ability to reduce appetite and to increase energy expenditure, the MC4R is a potentially attractive target for the development of antiobesity drugs.…”

Changes in Central 24-h Ambulatory Blood Pressure and Hemodynamics 12 Months After Bariatric Surgery: the BARIHTA Study

“…Most studies have reported a return to normal BP values in around 40-50% of obese hypertensive subjects after BS, without differences among the two most widely used techniques worldwide, gastric by-pass and sleeve gastrectomy [7][8][9][10]. However, in the vast majority of published studies the results rely on office BP measurements, and do not report data on ambulatory BP monitoring (ABPM), even though 24h-ABPM has been considered a better estimate of BP, with a recognized higher value in predicting cardiovascular events in hypertensives [11].…”

Resistant Hypertension in People With CKD: A Review

“…A further substudy of trial participants with RH found that the prevalence of apparent RH decreased in patients randomly assigned to Roux-en-Y gastric bypass. 85 Pharmacologic Treatment A proposed algorithm to the diagnosis and initial management of RH is shown in Figure 1. Suboptimal medication regimens are common in RH and pharmacotherapy is initially directed toward improving existing BP medications and simplifying dosing.…”