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The role of laparoscopic bariatric procedures in the improvement of pre-operative uncontrolled/resistant hypertension and its impact on the 10-year risk of cardiovascular disease.

David Romero Funes, MD, David Gutierrez Blanco, MD, Camila Ortiz Gomez, MD, Joel S Frieder, MD, Cristian Milla Matute, MD, Emanuele Lo Menzo, MD, Samuel Szomstein, MD, Raul Rosenthal, MD. Cleveland Clinic Florida

INTRODUCTION: Although several studies have addressed the improvement of hypertension (HTN) after bariatric surgery, only a few of them specifically addressed the effects of the procedures on uncontrolled/resistant HTN.  The aim of our study is to assess the remission of uncontrolled/resistant hypertension and its impact in the risk of cardiovascular disease (CVD) of morbidly obese patients following laparoscopic bariatric procedures.

METHODS: We retrospectively reviewed all patients who underwent Laparoscopic Bariatric surgery at our institution from 2010-2014. We used the guidelines of the American College of Cardiology (ACC) to define HTN and uncontrolled/resistant hypertension.  Only patients who met the criteria for the ACC and the calculation of the Framingham-BMI 10-year risk score pre-operatively at 3 months and at 12 months follow-up were included.

RESULTS: Of the 1,200 patients reviewed, 203(16.91%) met the required criteria of uncontrolled/resistant HTN according to the ACC and had the required variables for the risk assessment of CVD using the Framingham-BMI 10-year risk score. The most prevalent procedure was Laparoscopic sleeve gastrectomy LSG n=133 (65.51%). The most significant improvement found was an amelioration of 15mmhg and 13mmgh when comparing of systolic blood pressure pre-operatively, at 3 and 12 months follow-up respectively(P=0.0001). The improvement in the risk of CVD is shown by an absolute risk reduction(ARR) of 14% at 3 months and 15% at 12 months follow-up, both evidencing statistically significant  (P=0.0001)  In the patients with resistant hypertension the mean heart age was 80.81±9.11.

With regard to the Heart age, we observe an improvement of 6.76 and 7.33 years when comparing heart age pre-operatively, at 3 months and at 12 months follow-up. Both showing statistical significance (p=0.0001)

CONCLUSIONS: Our results suggest that laparoscopic bariatric procedures have a positive impact on patients with uncontrolled/resistant hypertension.  This results also translates into significant cardiovascular disease risk reduction. Furthermore, the Cardiovascular disease risk reduction also demonstrates a most dramatical improvement in patients with resistant hypertension. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95276

Program Number: P105

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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