Obesity, Hypertension, and Bariatric Surgery
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HYPERTENSION AND OBESITY (E REISIN, SECTION EDITOR)
Obesity, Hypertension, and Bariatric Surgery Rohan Samson 1 & Karnika Ayinapudi 1 & Thierry H. Le Jemtel 1 & Suzanne Oparil 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Obesity increases the risk of hypertension. However, blood pressure decreases before any significant loss of body weight after bariatric surgery. We review the mechanisms of the temporal dissociation between blood pressure and body weight after bariatric surgery. Recent Findings Restrictive and bypass bariatric surgery lower blood pressure and plasma leptin levels within days of the procedure in both hypertensive and normotensive morbidly obese patients. Rapidly decreasing plasma leptin levels and minimal loss of body weight point to reduced sympathetic nervous system activity as the underlying mechanism of rapid blood pressure decline after bariatric surgery. After the early rapid decline, blood pressure does not decrease further in patients who, while still obese, experience a steady loss of body weight for the subsequent 12 months. The divergent effects of bariatric surgery on blood pressure and body weight query the role of excess body weight in the pathobiology of the obesity phenotype of hypertension. Summary The decrease in blood pressure after bariatric surgery is moderate and independent of body weight. The lack of temporal relationship between blood pressure reduction and loss of body weight for 12 months after sleeve gastrectomy questions the nature of the mechanisms underlying obesity-associated hypertension. Keywords Obesity . Hypertension . Bariatric surgery . Adipose tissue
Introduction Epidemiological studies have clearly linked obesity to an increased risk for hypertension (HTN) [1, 2]. The prevalence of HTN was reported to be 43.6% in obese persons, 27.8% in overweight persons, and 15.3% in normal weight adult persons in the USA [3]. The underlying mechanisms of the obesity-HTN association and the specific contribution of obesity to HTN are areas of active investigation [4]. Crosssectional data indicate that the contribution of excess body This article is part of the Topical Collection on Hypertension and Obesity
weight to blood pressure (BP) may be only 20–30% in obese patients with HTN [5]. Bariatric surgery results in a greater and more sustained loss of body weight than intense life style interventions in patients with morbid obesity [6–8]. Close follow-up after bariatric surgery with serial measurements of BP and body weight allows to evaluate the effect of excess body weight on BP in patients with obesity and HTN. We review studies that recorded BP in the post-operative period and for the subsequent 12 months after Roux-en-Ygastric bypass (RYGB) or sleeve gastrectomy (SG) [9–12]. We then consider how the moderate weight-independent decrease in BP after bariatric surgery fits with current understanding of the obesity phenotype of HTN [13, 14].
* Thierry H. Le Jemtel [email protected]
Time Course of Blood Pressure D
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