Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenuew, SL-48, New Orleans, LA, 70112, USA.
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Curr Hypertens Rep. 2020 Jun 26;22(7):46. doi: 10.1007/s11906-020-01049-x.
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.
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. 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.
肥胖会增加高血压的风险。然而，在减重手术后，体重明显减轻之前，血压会下降。我们综述了减重手术后血压和体重之间暂时分离的机制。
限制型和旁路型减重手术可在数天内降低高血压和正常血压肥胖症患者的血压和血浆瘦素水平。血浆瘦素水平迅速下降和体重减轻最小表明，减重手术后血压迅速下降的潜在机制是交感神经系统活动减少。在早期快速下降之后，对于那些在随后的 12 个月中仍肥胖但体重持续稳定下降的患者，血压不会进一步下降。减重手术对血压和体重的不同影响质疑了超重在高血压肥胖表型的病理生理学中的作用。减重手术后血压下降适度且独立于体重。袖状胃切除术 12 个月后，血压降低与体重减轻之间缺乏时间关系，这对肥胖相关高血压的潜在机制的性质提出了质疑。
