AMBULATORY BLOOD PRESSURE PARAMETERS AMONG EXTREMELY OBESE SUBJECTS WITH DIFFERENT STAGES OF FATTY LIVER

Abstract

Objective: Obesity is one of the main causes of nonalcoholic hepatic steatosis. It is considered that fatty liver in patients with hypertension and without nocturnal dipping of blood pressure is connected with insulin resistance, diastolic heart failure and endothelial dysfunction. The aim of this study was to assess the changes in 24 h ambulatory blood pressure (ABP) mean values and variability to identify predictors of BP values in patients with extreme obesity and different stages of hepatic steatosis Design and method: Subjects were recruited to the study from the patients qualified to bariatric surgery. Body mass index (BMI), waist circumference (WC), hepatic ultrasonography (USG), ABP (Spacelabs 90207) and laboratory investigations were measured. Hepatic steatosis identified by USG was scored using a 0 to 3 scale. Data were analyzed in two groups: I–subjects without or with mild steatosis (USG score:0–1), II–subjects with moderate or severe steatosis (USG score:2–3). Results: Data from 104 patients (mean age 42,31 ± 11,15 years, 41,35% men) were analyzed. Patients in group I (n = 47) had lower BMI, WC and liver size values, lower levels of 24 hours and night-time diastolic blood pressure (DBP), day and night-time systolic blood pressure (SBP) and lower SBP short-term blood pressure variability expressed as standard deviation (SD) than group II (n = 57). There was no difference in night-time dipping between groups. Levels of glucose, lipids, transaminases, haemoglobin A1C and insulin resistance (HOMA IR) was also lower in group I than II, but hsCRP levels were similar in both groups. Day-time SD SBP positively correlated with BMI (r = 0,32) and WC (r = 0,34). Similar correlations were observed for day-time SD DBP (r = 0,21, r = 0,24, respectively). Night-time SD SBP positively correlated with WC (r = 0,47) and liver size (r = 0,54). Positive correlations was observed between 24 h SD SBP and liver size (r = 0,26). Conclusions: Besides anthropometric obesity indicators, the liver size may be the clinical predictor of higher blood pressure variability among extremely obese patients.