Key result
Laparoscopic sleeve gastrectomy resulted in hypertension remission in 71% of obese hypertensive patients at 15 months, associated with significant reductions in angiotensin II and other mediators.
Why the study?
The causal link between obesity and hypertension is established, but the detailed pathways and changes in vasoactive mediators following laparoscopic sleeve gastrectomy remain under investigation.
Does laparoscopic sleeve gastrectomy alter vasoactive mediators and induce hypertension remission in obese hypertensive patients?
Cohort (n=59)
Does laparoscopic sleeve gastrectomy alter vasoactive mediators and induce hypertension remission in obese hypertensive patients?
Laparoscopic sleeve gastrectomy induces hypertension remission in a majority of obese patients, associated with favorable alterations in the renin-angiotensin-aldosterone system and natriuretic peptides.
May support sleeve gastrectomy consideration in obese hypertensives; leaves open need for RCTs to confirm causality and durability.
INTRODUCTION: The causal relationship between obesity and high blood pressure is established; however, the detailed pathways for such association are still under research. This work aims to assess the changes in neprilysin, vasoconstrictor and vasodilatory molecules in obese hypertensive patients undergoing laparoscopic sleeve gastrectomy (LSG). PATIENTS: The present prospective study was done on 59 hypertensive obese patients in whom LGS was performed. Blood pressure, as well as blood samples for neprilysin, angiotensinogen, angiotensin II, renin, endothelin-1 "ET-1", aldosterone, atrial natriuretic peptide "ANP" and B-type natriuretic peptide "BNP", were assessed before and 15 months after surgery. Patients were divided into two groups according to the remission of hypertension (HTN). RESULTS: After 15 months, remission of hypertension was seen in 42 patients (71%). The declines in the following measurements were significantly higher in patients with remission than those with persistent HTN: aldosterone (p = .029567), angiotensin II (p < .000001), angiotensinogen (p = .000021), neprilysin (p = .000601), renin (p = .000454) and endothelin-1(p = .000030). There was a significantly higher increment in ANP (p = .000002) and a non-significant increment in BNP (p = .081740). Angiotensin II 15 months after LSG and Δ ANP % were significant independent predictors of persistent HTN. CONCLUSION: In the setting of LSG, aldosterone, angiotensinogen, angiotensin II, renin and neprilysin were significantly lower in patients with remission of HTN after 15 months than those with persistent HTN, and natriuretic peptides were significantly higher. A lower postoperative level of angiotensin II and a larger percentage increment of ANP are independently associated with hypertension remission after LSG.
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Salman et al. (2020) conducted a cohort in Obesity and hypertension (n=59). Laparoscopic sleeve gastrectomy vs. Baseline (pre-surgery) / Persistent hypertension group was evaluated on Remission of hypertension. Laparoscopic sleeve gastrectomy resulted in hypertension remission in 71% of obese hypertensive patients at 15 months, associated with significant reductions in angiotensin II and other mediators.
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