Devon Hawkins, MD, Balakrishna Prasad, PhD, Byron Faler, MD, Yong Choi, MD. Eisenhower Army Medical Center
Background: Bariatric surgery has become the most effective means for long term weight loss and resolution of comorbid conditions such as hypertension and diabetes. While the majority of the literature focuses on diabetes remission following bariatric surgery little has been reported on the time course to resolution of hypertension.
Objectives: The purpose of this study was to evaluate the time course to resolution of hypertension after bariatric surgery.
Methods: A retrospective chart review was performed evaluating 249 hypertensive and non-hypertensive patients who underwent bariatric surgery at DDEAMC between 2010-2012. Preoperative and postoperative measures of blood pressure, mean arterial pressure, body weight, BMI and prescription medications were recorded. An average preoperative blood pressure was used as the reference point. Postoperative values were recorded at interval time-points (1 week, 2 weeks, 3 months, 6 months, 1, 3 and 5 years) were analyzed for the above parameters. ANOVA with repeated measures was used to assess significant changes from preoperative values.
Results: Changes in mean arterial pressure was most substantial within the first two weeks following bariatric surgery despite maximum weight loss being reached at one year. At two weeks average MAP decreased by 7.2 mmHg (HTN -6.75mmHg vs Non HTN -7.6mmHg) despite mild changes in BMI and weight loss (-3.1 and -20.6 lbs respectively) . In comparison, at six months the average change in MAP from baseline had risen to -5.5mmHg (HTN -2.22mmHg vs Non HTN -10.77mmHg) in the setting of BMI change of -9.1 and weight loss of 57.3lbs. With maximum weight loss at one year, the difference in MAP was -6.1mmHg (HTN -3.5 mmHg vs Non HTN -9.7 mmHg) compared to baseline with BMI change of -11.9 and weight change of -71.3lbs.
Conclusion: Early decreases in blood pressure are not associated with any significant changes in body weight; however, as time continues there appears to be a linear relationship between late blood pressure changes and increase in body weight. Thus there may be two separate mechanisms responsible for blood pressure changes at early and late postoperative phases. One possible explanation is the immediate change in endocrine mediators following surgery. The majority of patients reach significant weight loss at one year followed by an observed steady weight gain by years 3 and 5. Early changes in blood pressure do not seem to be related to body weight changes however late blood pressure changes seem to have a more linear relationship.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79085
Program Number: MSS05
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium