Patients with Severe Obesity and Hypertension- Antihypertensive Treatment Before and After Bariatric Surgery-Five Years of Follow-Up
Beata Moczulska, Karolina Osowiecka, Leszek Gromadziński
Background: Hypertension is the most common comorbidity associated with obesity. Hypertension
can be treated with antihypertensive drugs, but weight loss can also lower BP, reducing the need for
antihypertensive medication. Bariatric surgery is the most effective treatment for patients with severe
obesity.
Material and methods: The study group consisted of 30 obese patients with hypertension or newly
diagnosed hypertension. Before laparoscopic sleeve gastrectomy (LSG) each patient was precisely
interviewed, taking into account the antihypertensive drugs taken. We divided drugs into groups: betablockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers
(ARBs), calcium channel blockers (CCBs), diuretics: thiazide diuretics / thiazide-like diuretics (TDs),
loop diuretics (LDs), mineralocorticoid receptor antagonists (MRAs) and others: centrally acting drugs
and alpha-blockers (ABs). Each patient had ABPM. Actually BMI and antihypertensive treatment was
assessed 5 years after LSG.
Results: The study group consisted of 30 patients with severe obesity (BMI≥40kg/m2) with an average
age of 42.5 years (25-69), including 11 males and 19 females.17 of patients had been previously
diagnosed and treated hypertension,13 had been newly diagnosed hypertension. The decrease in the
frequency of ACEIs use before and after SLG was significant observed (from 83% to 24%,p<0.001),
CCBs (from 45% to 14%, p=0.008), TDs (from 31% to 3.5%, p=0.013).The decrease of body mass
and BMI before and after SLG was significant(from 135kg to 100kg,p<0.001; 47.3 to 33.8, p<0.001).
Antihypertensive medication was discontinued in a large proportion of patients after surgery, and the
mean number of antihypertensive medications decreased. Bariatric procedures have strong evidence of
efficacy and safety.
Conclusions: Patients with severe obesity and hypertension should be offered surgical weight loss
earlier in their disease process.
