Effect of gastrectomy on blood pressure in early gastric cancer survivors with hypertension.

Abstract

We investigated the effect of gastrectomy on blood pressure (BP) in early gastric cancer survivors with hypertension and whether well-controlled BP was due solely to surgery-induced weight loss. The study enrolled 66 early gastric cancer patients with hypertension, undergoing endoscopic submucosal dissection (ESD), or gastrectomy. Blood analyses, 24-h ambulatory BP monitoring, brachial ankle pulse wave velocity (baPWV), and echocardiography were measured prior to, 3months after, and 1year after ESD or gastrectomy. The primary endpoint was remission of hypertension at 1year. The remission rate of hypertension was significantly higher in the gastrectomy group than in the ESD group (p = 0.006). Those with remission of hypertension had a significant weight loss (p < 0.001), decrease in body mass index (p < 0.001), 24-h total systolic BP (p = 0.047), baPWV (p = 0.042), triglycerides (p = 0.049) and apolipoprotein B/apolipoprotein A1 (p = 0.004), and an increase in high-density lipoprotein cholesterol (p < 0.001) at 1year. Upon multivariate logistic regression analysis, gastrectomy [odds ratio (OR) = 7.77, 95% confidence interval (CI) = 2.05-35.89], diuretic use (OR = 3.76, 95% CI = 1.14-13.98), and lower 24-h total diastolic BP before treatment (OR = 0.90, 95% CI = 0.82-0.96) were predictive of remission of hypertension after adjusting for percent weight. In early gastric cancer survivors with hypertension, gastrectomy resulted in better BP control than did ESD, which may be due to the gastrectomy itself, beyond weight loss. Therefore, it should be remembered that the adequate reduction of antihypertensives may be necessary in early gastric cancer survivors after gastrectomy.