Department of Cardiology, Internal Medicine, Howard University Hospital, Washington, DC, USA.
Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Sci Rep. 2021 Jan 18;11(1):1683. doi: 10.1038/s41598-021-81360-y.
Weight reduction continues to be first-line therapy in the treatment of hypertension (HTN). However, the long-term effect of bariatric malabsorptive surgical techniques such as Roux-en-Y Gastric Bypass (RYGB) surgery in the management of hypertension (HTN) is less clear. African Americans (AA) are disproportionately affected by obesity and hypertension and have inconsistent outcomes after bariatric surgery (BS). Despite a plethora of bariatric literature, data about characteristics of a predominantly AA bariatric hypertensive cohort including hypertension in obese (HIO) are scarce and underreported. The aims of this study were, (1) to describe the preoperative clinical characteristics of HIO with respect to HTN status and age, and (2) to identify predictors of HTN resolution one year after RYGB surgery in an AA bariatric cohort enrolled at the Howard University Center for Wellness and Weight Loss Surgery (HUCWWS). In the review of 169 AA bariatric patients, the average BMI was 48.50 kg/m and the average age was 43.86 years. Obese hypertensive patients were older (46 years vs. 37.89 years; p < .0001); had higher prevalence of diabetes mellitus (DM, 43.09% vs. 10.87%; p < .0001) and dyslipidemia (38.2% vs. 13.04%; p 0.002). Hypertensive AA who were taking ≥ 2 antihypertensive medications prior to RYGB were 18 times less likely to experience HTN resolution compared to hypertensive AA taking 0-1 medications, who showed full or partial response. Also, HIO was less likely to resolve after RYGB surgery in patients who needed ≥ 2 antihypertensive medications prior to surgical intervention.
减肥仍然是治疗高血压(HTN)的一线治疗方法。然而,胃旁路手术(RYGB)等减肥吸收不良手术技术在高血压(HTN)管理中的长期效果尚不清楚。非裔美国人(AA)不成比例地受到肥胖和高血压的影响,并且在减肥手术后(BS)的结果不一致。尽管有大量的减肥文献,但关于主要是 AA 的肥胖高血压患者群体的特征的数据,包括肥胖中的高血压(HIO)的数据很少且报道不足。本研究的目的是:(1)描述 HIO 与 HTN 状态和年龄相关的术前临床特征;(2)确定在霍华德大学健康与体重管理手术中心(HUCWWS)接受 RYGB 手术的 AA 减肥队列中,一年后 HTN 缓解的预测因素。在对 169 名 AA 减肥患者的回顾中,平均 BMI 为 48.50 kg/m,平均年龄为 43.86 岁。肥胖高血压患者年龄较大(46 岁比 37.89 岁;p <.0001);糖尿病(DM,43.09%比 10.87%;p <.0001)和血脂异常(38.2%比 13.04%;p <.0001)的患病率更高。在接受 RYGB 之前服用≥2 种降压药的高血压 AA 患者,与服用 0-1 种降压药的高血压 AA 患者相比,HTN 缓解的可能性降低 18 倍,这些患者表现出完全或部分反应。此外,在接受手术干预之前需要服用≥2 种降压药的患者中,HIO 在 RYGB 手术后更不可能得到解决。