Sleeve gastrectomy prevents hypertension associated with unique shifts in the gut microbiome.

Abstract

Bariatric surgery results in resolution of hypertension in over 50% of patients. While weight loss is a critical component to hypertension resolution after bariatric surgery, there may also be weight loss-independent mechanisms. We hypothesized that sleeve gastrectomy (SG) initiates changes in the gut microbiome which reduce postoperative blood pressure. Male, obese Zucker rats underwent SG, pair-fed sham, or ad-lib-fed sham surgery. Blood pressure measurements were performed 1 week pre-operatively, and at 2 and 6weeks post-operatively. The stool microbiome composition was determined by 16S rDNA gene at 6weeks post-operatively. Regression Random Forest modeling was performed to determine an association of the microbial composition with blood pressure. SG and pair-fed rats weighed significantly less than ad-lib-fed sham rats throughout the post-surgical period. At 6weeks after surgery, SG rats had a significantly lower systolic blood pressure (149.2 ± 1.99mmHg) than pair-fed (164.7 ± 7.87, p < 0.001) or ad-lib-fed sham rats (167.1 ± 2.41mmHg, p < 0.001). There was a significant difference in multiple measures of beta diversity between SG rats and pair-fed and ad-lib-fed sham rats. 45.11% of the difference in blood pressure variability between samples was explained with the regression Random Forest model. SG in a rat model prevented hypertension progression independent of weight loss with changes in beta diversity and gut bacterial composition associated with the blood pressure outcome. These findings further support the metabolic efficacy of SG in treating hyperglycemia, cardiac dysfunction, and now hypertension, independent of obesity class.