title: Effect of weight loss on abnormal 24-hour blood pressure patterns in severely obese patients.
abstract: BACKGROUND
  Nocturnal hypertension (night systolic [S]/diastolic [D] blood pressure [BP]≥120/70 mm Hg), nondipper status (nocturnal BP fall<10% of daytime values), and pulse pressure ([PP]; difference between 24-h SBP and DBP readings) are associated with increased risk of cardiovascular disease. We evaluated the 1-year effect of significant surgical weight loss (WL) on abnormal BP patterns in patients with and without hypertension and identified the factors involved.
  
  
  METHODS
  University hospital, Spain.
  
  
  METHODS
  This prospective study included 42 patients (28 normotensive [NT] and 14 hypertensive [HT]), 71% women with a mean age (standard deviation [SD]) of 48 (11) years undergoing bariatric surgery (BS): 22 laparoscopy Roux-en-Y gastric bypass (LRYGB) and 20 sleeve gastrectomy (SG). SG: 20. Before and 12 months post-BS, anthropometric data, BP (24-h ambulatory BP measurement), and metabolic parameters were determined. At 12 months post-BS ultrasonographic carotid assessment was performed in a subgroup of patients (22).
  
  
  RESULTS
  Both groups experienced significant WL (percent of excess body weight loss [%EBWL] 68%), a fall in 24-h SBP of-13 (11)/DBP-3 (7) mm Hg, and improvement in all the metabolic parameters evaluated and the homeostatic model assessment of insulin resistance (HOMA-IR). However, nondipper status remained high in NT (54%) and HT (64%) as well as 60% of the patients with carotid plaque. Additionally, in HT patients nocturnal hypertension and PP remained significantly higher, and basal fasting insulin values and the HOMA-IR score were significantly higher in those not normalizing dipper status.
  
  
  CONCLUSIONS
  Surgery-induced WL was associated with a sizeable decline in BP and metabolic parameters improvement. However, independent of the presence of hypertension, the prevalence of abnormal 24-h BP patterns remained high, and thus, cardiovascular risk continued to be high in these patients.
authors.affiliation: Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain. Electronic address: mccareag@clinic.ub.es.
authors.forename: Maria
authors.initials: M
authors.lastname: Careaga
authors.affiliation: CIBERDEM: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain; Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Esmatjes
authors.affiliation: Diagnostic Imaging Center, Hospital Clinic, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Nuñez
authors.affiliation: Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain.
authors.forename: Judit
authors.initials: J
authors.lastname: Molero
authors.affiliation: Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain; CIBERDEM: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Vidal
authors.affiliation: Obesity Unit, Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain; CIBERDEM: Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Barcelona, Spain.
authors.forename: Lilliam
authors.initials: L
authors.lastname: Flores
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D015431:Weight Loss / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents
keywords: Bariatric surgery; Blood pressure; Hypertension; Nondipper status; Pulse pressure; Weight loss