The Effects of Sleeve Gastrectomy on Blood Pressure, Blood Pressure Variability, and Autonomic Functions in Severely Obese Patients Without Diabetes or Hypertension

Background/Objectives: Laparoscopic sleeve gastrectomy (LSG) treats severe obesity, but data on its effects on 24 h blood pressure (BP) patterns, blood pressure variability (BPV), and cardiac autonomic nervous system (CANS) in obese patients without hypertension or diabetes are limited. We evaluated these parameters before and after LSG. Methods: 78 patients with severe obesity (BMI ≥ 40 kg/m2) without hypertension or diabetes who underwent LSG between January 2016 and December 2019 were included in the study. Patients underwent ambulatory blood pressure monitoring (ABPM), ambulatory electrocardiographic monitoring, and laboratory tests before and six months after surgery. Results: Preoperative ABPM was characterized by a significant proportion of masked hypertension (43.5%), high 24 h BP (mean SBP 138.9 ± 5.5 mmHg, DBP 81.1 ± 4.9 mmHg), high BP load (39% SBP, 38% DBP), and a non-dipper pattern (67.9%). After LSG, significant improvements were observed in mean 24 h SBP, DBP (p < 0.001), BPV, BP load, and non-dipper patterns. HRV parameters (SDANN, RMSSD) increased significantly (p < 0.001) and HRT parameters improved: TO became more negative from −0.54 ± 1.73 to −2.53 ± 1.97, TS increased from 5.98 ± 3.49 to 9.87 ± 4.28 ms/RR (p < 0.001). We found a strong association between decreased body mass index and BP changes. Changes in glucose, HbA1c, and HOMA-IR predicted CANS improvement (β = 0.24–0.38; R2 = 20.8–29.7%). Conclusions: Six months after LSG, significant improvements in BP, BPV, and CANS were observed. BP reduction was primarily associated with weight loss, while glucose control was associated with autonomic improvements. LSG was associated with early improvements in surrogate cardiovascular risk markers through combined weight-dependent and metabolic-hormonal mechanisms.