CHANGES OF PULSE WAVE VELOCITY AND THE EFFECTIVENESS OF BLOOD PRESSURE CONTROL IN PATIENTS WITH HYPERTENSION AND MORBID OBESITY AFTER BARIATRIC SURGERY

Abstract

Objective: Research objective was studying of pulse wave velocity (PWV) changes and the effectiveness of blood pressure (BP) control in obese patients after bariatric treatment. Design and method: It were surveyed 22 untreated patients (11 males) with morbid obesity. The body mass index before the surgery was 47.6 ± 2.14 kg/m2. Hypertension was detected in 20 (90.9%) patients: grade 1 was established in 9 (40.9%), grade 2 - in 8 (36.4%) and grade 3 - in 3 (13.6%) patients. According to target organ damage stage I hypertension was established in 4 (18.2%), stage II in 16 (72.7%) patients. Low cardiovascular (CV) risk was established in 1 (4.55%) patient, moderate CV risk in 1 (4.55%) patient, high CV risk in 16 (72.7%) patients, very high CV risk in 4 (18.2%) patients. The combined antihypertensive therapy was prescribed to all patients with hypertension and obese before surgery to reach normal BP values. As a result 2-component therapy was prescribed to 6 (27,3%) patients, 3-component therapy - to 8 (36,4%), 4-component therapy - to 5 (22,7%), 5-component therapy - to 1 (4,55%) patient. The effectiveness of the prescribed antihypertensive therapy was evaluated using office BP measurement. BP control in all patients was repeated after bariatric treatment. Results: Systolic BP level significantly decreased from 152,60 ± 5,71 mm Hg to 121,70 ± 3,02 mmHg (p < 0,001) after bariatric surgery. Diastolic BP also declined during estimated period from 86,20 ± 3,13 to 69,0 ± 2,92 mm Hg (p < 0,001). PWV levels decreased from 8,66 ± 0,27 to 7,14 ± 0,46 (p < 0,005). Significant positive results achieved after bariatric treatment allowed 5 (22.7%) patients first to reduce dosages, and subsequently to stop taking antihypertensive therapy in order to achieve normotension, and 15 (68.2%) patients - significantly to reduce dosages and quantity of taken drugs. Conclusions: Weight loss as a result of surgical treatment of obesity significantly improves BP control and PWV level in patients with morbid obesity, allows to reduce doses and the number of taken medications, to achieve not only long-term weight loss, but also to reduce the risk of serious CV events. This category of patients requires careful further dynamic monitoring by a multidisciplinary team of specialists.