John W Deming Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Surgical Specialists of Louisiana, Metairie, LA, USA.
J Investig Med. 2021 Mar;69(3):730-735. doi: 10.1136/jim-2020-001586. Epub 2020 Dec 21.
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) reduce blood pressure (BP) in obese patients with hypertension (HTN). We compared the effect of RYGB and SG on BP in obese patients with HTN at a large-volume, private bariatric surgery center using a propensity score analysis. The measurement and management of BP were exclusively left to the patient's provider without any involvement of Tulane investigators. At month 1, RYGB and SG equally decreased: (1) mean body weight: 12.7 vs 13.2 kg (p=not significant (NS)) (2) systolic/diastolic BP: 8.5/5.3 vs 8.0/4.2 mm Hg (p=NS) and (3) average number of antihypertensive medications from 1.5 to 0.8 and from 1.6 to 0.6 per patient (p=NS). From month 1 to 12, BP remained unchanged after RYGB but tended to increase from month 6 to 12 after SG. Remission of HTN occurred in 52% and 44% of patients after RYGB and SG. In contrast to the full effect of RYGB and SG on BP at 1 month, body weight decreases steadily over 12 months after RYGB and SG. In conclusion, early after surgery, RYGB and SG equally reduce BP in obese patients with HTN. Thereafter, RYGB has a more sustained effect on BP than SG.
胃旁路手术（RYGB）和袖状胃切除术（SG）可降低肥胖合并高血压（HTN）患者的血压（BP）。我们在一家大型私立减重手术中心，采用倾向评分分析比较了 RYGB 和 SG 对肥胖合并 HTN 患者 BP 的影响。BP 的测量和管理完全由患者的提供者负责，没有任何杜兰大学研究人员的参与。在第 1 个月，RYGB 和 SG 同样降低了：（1）平均体重：12.7 与 13.2kg（p=无显著差异（NS））；（2）收缩压/舒张压：8.5/5.3 与 8.0/4.2mmHg（p=NS）；（3）平均降压药物数量从 1.5 种减少至 0.8 种和从 1.6 种减少至 0.6 种/每位患者（p=NS）。从第 1 个月到第 12 个月，RYGB 后 BP 保持不变，但 SG 后从第 6 个月到第 12 个月趋于增加。RYGB 和 SG 后分别有 52%和 44%的患者 HTN 缓解。与 RYGB 和 SG 在第 1 个月对 BP 的完全作用相反，RYGB 和 SG 后体重在 12 个月内持续下降。总之，RYGB 和 SG 在肥胖合并 HTN 患者术后早期同样降低 BP。此后，RYGB 对 BP 的持续作用强于 SG。
