Patients with Severe Obesity and Hypertension- Antihypertensive Treatment Before and After Bariatric Surgery-Five Years of Follow-Up

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