Remission Of Hypertension Research Articles

Remission of hypertension after laparoscopic sleeve gastrectomy versus Roux-en-Y-gastric bypass: a systematic review of randomized control trials

BackgroundBesides its benefits for weight loss, current findings suggest that bariatric surgery can induce remission of hypertension. Limited data report the effect of bariatric surgery on this obesity-associated comorbidity. ObjectiveCompare the short-term, mid-term, and long-term remission of hypertension after sleeve gastrectomy versus Roux-en-Y gastric bypass MethodsFour databases (Embase, PubMed, Scopus, and Science Direct) were searched for randomized controlled trials (RCTs) that compared the effects of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) on hypertension remission at <1 year, 2–4 years, and ≥5 years. Patients with a history of hypertension and who had primary bariatric surgery were included. ResultsAfter reviewing 11,814 studies, only 11 RCTs were included. In total, the analysis included 2323 patients, with 1158 in the SG group (49.85%) and 1165 in the RYGB group (50.15%). It was found that SG and RYGB procedures had comparable hypertension remission at ≤1 year (Relative risk: 1.11, 95% CI .83–1.48, P = .49), and between 2 and 4 years (Relative risk: 1.11, 95% CI .90–1.37, P = .34). However, there was a significant difference in hypertension remission at ≥ 5 years, favoring RYGB (relative risk: 1.39, 95% CI 1.06–1.82, P = .02). ConclusionThis systematic review and meta-analysis of RCTs demonstrates that RYGB is superior to SG in resolving hypertension beyond 5 years postoperatively. These findings highlight the long-term benefits of RYGB over SG in managing hypertension, providing valuable insights for surgical decision-making and patient counseling.

Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity-score matched analysis

BackgroundPrevious studies comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are often limited by retrospective designs, or in randomized controlled trials, by small sample sizes or limited follow-up durations. ObjectivesThis study aims to compare OAGB and RYGB during 5years of follow-up in terms of weight loss, remission of comorbidities, and complications. SettingThis longitudinal prospective study includes all patients who underwent a primary OAGB or RYGB between 2015 and 2016 in the Netherlands, utilizing data from the nationwide registry, Dutch Audit for Treatment of Obesity. MethodsA 1:1 propensity-score matched (PSM) comparison between patients with OAGB and RYGB. ResultsAfter 1:1 PSM, 2 nearly identical cohorts of 860 patients were obtained. OAGB was associated with more intraoperative complications (2.0% versus .6%; P = .031). Conversely, RYGB had a higher rate of short-term complications (7.6% versus 3.8%; P < .001). Five-year data were available from 40.7% of the patients with OAGB and 34.9% with RYGB. No significant differences were observed in percentage total weight loss after 5years (30.0% after OAGB and 28.8% after RYGB; P = .099). The total remission rate of diabetes mellitus was 60.5% for OAGB and 69.4% for RYGB (P = .656). However, OAGB resulted in a significantly higher remission rate of hypertension compared to RYGB (60.2% versus 45.5%; P = .015). ConclusionsOAGB and RYGB yield comparable weight loss outcomes. However, OAGB had more intraoperative complications, while RYGB had more short-term complications. Both procedures show similar efficacy in diabetes mellitus remission, but OAGB is more effective in achieving hypertension remission.

Prognostic Role of Hypertension Remission in Kidney Transplant Recipients with Pretransplant Hypertension

Prognostic Role of Hypertension Remission in Kidney Transplant Recipients with Pretransplant Hypertension

Abstract MP08: Long-Term Impact of Bariatric Surgery on Hypertension Control and Remission: A Meta-Analysis of Randomized Controlled Trials

Background: Bariatric surgery is widely recognized as a highly effective intervention for addressing obesity and its associated metabolic complications. However, there is a paucity of evidence from randomized controlled trials (RCTs) with primary endpoints focusing on its impact on hypertension. Objective: We aimed to synthesize findings from pivotal RCTs until May 2024 to evaluate the long-term effects of bariatric surgery on hypertension in obese individuals compared to medical or lifestyle management. Methods: We analyzed data using RevMan 5.4 with a random effects model, employing the inverse variance method to report outcomes as risk ratios (RR) or weighted mean differences (WMD) with 95% confidence intervals (CI). Our study protocol is registered in PROSPERO (CRD42024527369). Results: The study comprised 18 RCTs involving 1386 obese patients (62.7% women) with a mean BMI of 38 kg/m 2 and an average follow-up duration of 1 to 5 years. On pooled analysis, there was a statistically significant difference in the rate of hypertension remission between patients who underwent bariatric surgery versus patients on medical/lifestyle management with an RR of 2.77 (95% CI: 1.26 to 6.10, p = 0.01). Additionally, a substantial reduction in the use of antihypertensive medications while maintaining controlled blood pressure was observed (RR: 7.10; 95% CI: 4.38 to 11.51, p &lt; 0.00001), with no heterogeneity. Bariatric surgery also significantly improved systolic blood pressure control (WMD: -3.67; 95% CI: -5.53 to -1.80, p = 0.0001). Conclusion: Bariatric surgery emerges as a durable solution for obesity-related hypertension, offering remission and control of hypertension while reducing the dependence on antihypertensive medications.

Digital Twin in Managing Hypertension Among People With Type 2 Diabetes: 1-Year Randomized Controlled Trial

BackgroundDigital twin (DT)-guided lifestyle changes induce type 2 diabetes (T2D) remission but effects on hypertension (HTN) in this population are unknown. ObjectivesThe purpose of this study was to assess effects of DT vs standard of care (SC) on blood pressure (BP), anti-HTN medication, HTN remission, and microalbuminuria in participants with T2D. MethodsThis is a secondary analysis of a randomized controlled trial in India of 319 participants with T2D. Participants were randomized to DT group (N = 233), which used artificial intelligence-enabled DT technology, or SC group (N = 86). A Home Blood Pressure Monitoring system guided anti-HTN medication adjustments. BP, anti-HTN medications, HTN remission rates, and microalbuminuria were compared between groups. ResultsAmong the 319 participants, 44 in DT and 15 in SC group were on anti-HTN medications, totaling 59 (18.4%) participants. DT group achieved significant reductions in systolic blood pressure (−7.6 vs −3.2 mm Hg; P < 0.007) and diastolic blood pressure (−4.3 vs −2.2 mm Hg; P = 0.046) after 1 year compared with SC group. 68.2% of DT group remained off anti-HTN medications compared to none in SC group. Among participants with HTN, DT subgroup achieved higher rates of normotension (40.9% vs 6.7%; P = 0.0009) and HTN remission (50% vs 0%; P < 0.0001) than SC subgroup. DT group had a higher rate of achieving normoalbuminuria (92.4% vs 83.1%; P = 0.018) at 1 year compared with SC group. ConclusionsArtificial intelligence -enabled DT technology is more effective than SC in reducing BP and anti-HTN medications and inducing HTN remission and normoalbuminuria in participants with HTN and T2D. (A Novel WholeBody Digital Twin Enabled Precision Treatment for Reversing Diabetes; CTRI/2020/08/027072)

Long-term trajectories of weight loss and health outcomes: protocol of the SCOOP-RNPC nationwide observational study

IntroductionBehavioural weight loss programmes are generally accepted as being beneficial in reducing cardiometabolic risk and improving patient-reported outcomes. However, prospective data from large real-world cohorts are scarce concerning the mid-term...

Remission to normal blood pressure in older adults with hypertension who did not receive antihypertensive medication: analysis of data from two longitudinal cohorts

How often hypertensive patients could achieve remission to normal blood pressure (BP) (i.e., <140/90mmHg) in the absence of antihypertensive drugs, which is important for the management of hypertension, remains largely unknown. This observational study aimed to investigate the change of BP in older adults with hypertension who did not take antihypertensive drugs and preliminarily examine whether the remission from hypertension to normal BP observed in this setting was associated with lower risk of cardiovascular disease (CVD). 2760 participants aged 33-99 years (median 60 years, interquartile 54-68 years) from the Health and Retirement Study (wave 2006 to wave 2018) and the English Longitudinal Study of Ageing (wave 1998 to wave 2016), who had no major CVD, were hypertensive, and were not on antihypertensive drugs at the time of baseline BP measurement, and had at least one follow-up BP measurement before which no antihypertensive drugs were taken, were included for analysis. The main outcome was the proportion of patients who achieved remission of hypertension at the last wave of measurement. During a median follow-up of six years, 52% of the participants showed a reduction of ≥6mmHg in systolic BP and 60% a reduction of ≥3mmHg in diastolic BP. 1171 participants (42%, 95% CI: 41-44%) achieved remission at the last measurement, and by that time 67%, 43%, and 29% of them had maintained the normotensive state for around 4, 8, and 12 years, respectively. Various supplementary analyses that aimed to examine the impact of chance and bias yielded similar results. Preliminary analyses showed that being non-smokers at baseline, achieving a normal body mass index during follow-up, and quitting alcohol drinking during follow-up, among others, were associated with the remission of hypertension. Compared with the participants who remained hypertensive, those who achieved remission had a lower CVD risk (adjusted hazard ratio 0.66, 95% CI: 0.47-0.92). In many of this study population, hypertension could be reversed without the intervention of drug treatment in the first few years after diagnosis. This finding may have implications for more individualized management of hypertension. Further studies to identify the factors or algorithms predictive of such hypertension remission are warranted. The Chinese University of Hong Kong (7106452; 7105959),Shenzhen Science and Technology Program (KQTD20190929172835662), Strategic Priority Research Program of Chinese Academy of Sciences (XDB 38040200), National Institute on Aging(R01AG017644; NIA U01AG009740).

Subarachnoid Hemorrhage as the First Manifestation of Pheochromocytoma with Remission of Hypertension and Diabetes Mellitus Postsurgery

Abstract Pheochromocytoma, a rare but life-threatening etiology of secondary hypertension, must be considered in patients with unexplained deterioration of glycemic control and new onset or worsening hypertension. We present the case of a 52-year-old female recently diagnosed with type 2 diabetes mellitus (T2DM) with a history of hypertension and subarachnoid hemorrhage (SAH), who reported intermittent headaches and palpitations at a routine checkup. Further evaluation confirmed elevated levels of urinary and plasma metanephrines, and imaging revealed a mass lesion in the right adrenal gland consistent with pheochromocytoma. The patient underwent laparoscopic right adrenalectomy with successful resolution of hypertension and diabetes. This case underscores considering pheochromocytoma as a differential in cases of hypertensive emergency or resistant hypertension, highlighting the potential for remission of hypertension and T2DM following tumor removal.

Establishment of a scoring model for predicting clinical outcomes in patients with unilateral primary aldosteronism after superselective adrenal artery embolization.

Superselective adrenal arterial embolization (SAAE) is a potential alternative treatment for patients with unilateral primary aldosteronism (PA) who refuse unilateral adrenalectomy. Therefore, we aimed to establish a scoring model to differentiate between hypertensive remission after SAAE. This prospective cohort study involved 240 patients who underwent SAAE for unilateral PA. Patients were randomly divided into a model training set and a validation set at a ratio of 7:3. The clinical outcome was a response to hypertension remission, defined as complete, partial, or absent success at 6 months after SAAE. Multivariate logistic regression was performed to identify independent parameters and develop a nomogram to predict clinical outcomes after SAAE. The discrimination, calibration efficacy, and clinical utility of the predictive model were assessed. Five independent predictors were identified: female sex, duration of hypertension, defined daily dose of antihypertensive medication, diabetes, and target organ damage. The above five independent predictors were put into a predictive model that was presented as a nomogram. Using bootstrapping for internal validation, the C-statistic for the predictive model was 0.866 (95% confidence interval [CI]: 0.834 to 0.898). In the validation cohort, the area under the curve (AUC) of the nomogram for predicting hypertension remission after SAAE was 0.809. The present model is the first nomogram-based score that specifically predicts hypertension remission after SAAE in patients with unilateral PA using conventional parameters. This is an effective risk stratification tool that can be used by clinicians for timely and tailored preoperative risk discussions.

The Therapeutic Effectiveness of Laparoscopic Sleeve Gastrectomy Among Individuals with Low BMI Obesity (30-35 Kg/m2) and the Relationship of BMI to Weight Loss.

Investigating the therapeutic efficacy of Laparoscopic Sleeve Gastrectomy (LSG) in low BMI (30-35 kg/m2) patients with obesity, and exploring the correlation between patients' preoperative BMI and postoperative weight loss. Comparing the weight loss, remission of comorbidities, occurrence of complications, and quality of life among the different BMI patients who underwent LSG. Analyzing the relationship between BMI and percentage of excess weight loss (%EWL) by using Spearman correlation analysis and linear regression analysis. The %EWL at 12 months after the surgical procedure was (104.26±16.41)%, (90.36±9.98)%, and (78.30±14.64)% for patients with Class I, II, and III obesity, respectively, P<0.05. Spearman correlation coefficients between %EWL and BMI at 1, 3, 6, and 12 months after surgery were R=-0.334 (P<0.001), R=-0.389 (P<0.001), and R=-0.442 (P<0.001), R=-0.641 (P<0.001), respectively. The remission of hypertension, diabetes and dyslipidaemia did not differ significantly between groups (P>0.05). Individuals with obesity for varying BMI can experience favorable outcomes following LSG surgery. It is advisable to consider LSG treatment for patients with Class I obesity.

Contralateral Suppression in Adrenal Venous Sampling Predicts Clinical and Biochemical Outcome in Primary Aldosteronism.

The role of hormone parameters at adrenal venous sampling (AVS) in predicting clinical and biochemical outcomes remains controversial. To investigate the impact of hormone parameters at AVS under cosyntropin stimulation on lateralization and on complete biochemical and clinical outcomes. We retrospectively evaluated 150 sequential AVS under cosyntropin infusion. The bilateral successful cannulation rate was 83.3% (n = 140), 47.9% bilateral and 52.1% unilateral. The lateralization index, aldosterone/cortisol ratio (A/C) in the dominant adrenal vein (AV), and relative aldosterone secretion index (RASI = A/C in AV divided by A/C in inferior vena cava) were assessed. The contralateral suppression (CS) percentage was defined by (1 - nondominant RASI) * 100. A nondominant RASI <0.5 (CS >50%) had 86.84% sensitivity and 92.96% specificity to predict contralateral lateralization. An A/C ratio in dominant AV >5.9 (74.67% sensitivity and 80% specificity) and dominant RASI >4.7 (35.21% sensitivity and 88.06% specificity) had the worst performance to predict ipsilateral lateralization. Complete biochemical and clinical cure was significantly more frequent in the patients with CS >50% [98.41% vs 42.86% (P < .001) and 41.94% vs 0% (P < .001)]. CS correlated with high aldosterone at diagnosis (P < .001) and low postoperative aldosterone levels at 1 month (P = .019). Postoperative biochemical hypoaldosteronism was more frequent in patients with CS >50% (70% vs 16.67%, P = .014). In multivariable analysis, a CS >50% was associated with complete biochemical cure [odds ratio (OR) 125, 95% confidence interval (CI) 11.904-5000; P = .001] and hypertension remission (OR 12.19, 95% CI 2.074-250; P = .023). A CS >50% was an independent predictor of complete clinical and biochemical cure. Moreover, it can predict unilateral primary aldosteronism and postoperative biochemical hypoaldosteronism. Our findings underscore the usefulness of CS for clinical decision-making.

Impact of Intensive Lifestyle Intervention on Remission of Metabolic Syndrome, Prediabetes, Diabetes, and Hypertension in Adults Living with Obesity

Background: Lifestyle intervention programs have long been shown to be effective in preventing cardiometabolic risk factors (CMRFs) such as metabolic syndrome (MS), impaired fasting glycaemia (IFG), type II diabetes (T2DM), and hypertension (HTA). However, their potential for remission of these CMRFs in overweight/obese adults is less clear. The importance of attaining remission has significantly increased as these CMRFs are more and more prevalent. Objectives: The aim of this study is to determine the impact of an intensive lifestyle intervention program on the remission of MS, IFG, T2DM, and HTA in overweight/obese adults. Methods: Forty participants living with overweight/obesity were enrolled in an 18-month multidisciplinary primary prevention body mass loss intervention program. MS, IFG, T2DM, and HTA statuses were assessed at baseline, 9 months, and the end of the program. Results: At baseline, 25 participants (64.1%) had MS, 7 (17.9%) had IFG, 4 (10.2%) were living with diabetes, and 28 (70.0%) had HTA. At 18 months, six (24%) of the participants living with MS, two (28.6%) of the participants with IFG, two (50%) of the participants with diabetes, and two (7.1%) of the participants with HTA met all criteria for remission. Conclusion: An intensive lifestyle intervention program consisting of monitored exercise training and lifestyle modification counselling has great potential for achieving remission of CMRFs in adults living with overweight/obesity.

SAFETY AND OUTCOMES OF SLEEVE GASTRECTOMY AND GASTRIC BYPASS: A SYSTEMIC REVIEW

The purpose of the current investigation is to compare the safety and outcomes of Sleeve Gasterectomy with Gastric Bypass in patients.Up to February 2022, appropriate papers were screened from the published literature. The RevMan 5.1 software was used to conduct the meta-analysis.There were twenty studies included in this meta-analysis. GB had a greater incidence of both early and late problems than SG. Leaks, UTIs, obstructions, and deaths happened more frequently in the GB group within a month following surgery. The discrepancies could lead to excellent rates of readmission to the hospital and a need for additional surgery. When it came to remission of hypertension and the weight loss outcome at one year, GB beat out SG. However, in type 2 diabetes,no differences were observed in OSA or the weight loss outcome after two or three years.SG was a better alternative for individuals than GB because SG is as effective and safer than GB.

Predictors of complete remission of hypertension in patients over 65 years of age after bariatric surgery - a multicenter study.

In the era of an aging society and a growing number of obese people, an increasing number of older patients are consulting bariatric surgeons. The incidence of hypertension (HT) also rises with age and body weight, making the treatment of the elderly a significant challenge. To identify predictors of HT remission after bariatric surgery in patients over 65 years of age. A retrospective study analyzed patients over 65 years old with HT who underwent laparoscopic bariatric procedures in Poland between 2008 and 2022. The data came from 11 bariatric centers. Patients were categorized into two groups: responders (R) and non-responders (NR). A multivariate logistic regression analysis was conducted to identify significant independent risk factors. The study analyzed 244 patients, with complete HT remission observed in 55 (22.5%) patients. Almost 90% of patients showed improvement in HT. The mean follow-up time was 47.4 months. Factors contributing to HT remission included HT duration of less than 5 years, the use of single medication, and a significant correlation with %EWL. Bariatric surgery in patients aged over 65 has a positive effect on HT remission. The chance of HT remission increases with fewer medications, shorter HT duration, and greater weight loss after surgery.

Laparoscopic single anastomosis sleeve ileal bypass in the surgical management of morbid obesity: A single‐centre experience

AbstractBackgroundSingle anastomosis sleeve ileal (SASI) bypass is a recently developed two‐step bariatric operation that involves a sleeve gastrectomy followed by a side‐to‐side sleeve‐ileal anastomosis. While the primary outcomes are promising, more evidence is required before SASI can be considered a standard bariatric procedure.ObjectiveThis study aims to evaluate short‐term outcomes of SASI bypass regarding safety, efficacy and complications.MethodsThis retrospective study involved the analysis of 75 patients who underwent SASI between January 2019 and January 2022. The study examined patients’ characteristics, comorbidities, surgical technique, operative details, post‐operative weight loss and complications.ResultsOf the 88 patients who underwent SASI, 13 were excluded, leaving 75 participants for analysis. The mean age was 36.9 ± 8.3 years, and the mean body mass index was 49.23 ± 5.5 kg/m2. Among the participants, 19 patients (25.3%) had diabetes and 8 patients (10.6%) had hypertension. The mean operative time was 78.42 ± 13.18 min. The mean excess weight loss percentage was 25.53 ± 3.63, 43.33 ± 8.78, 63.51 ± 10.85, 82.11 ± 11.42 and 88.95 ± 8.69 at 1, 3, 6, 12 and 24 months, respectively. The diabetic remission rate was 100%, and the hypertension remission rate was 75%. Post‐operative complications were observed in 12 patients (16%), with most being minor. Notably, two patients underwent SASI reversal to sleeve gastrectomy due to excessive weight loss, and one patient experienced weight regain in the second post‐operative year.ConclusionSASI bypass emerges as a straightforward and highly effective bariatric procedure, with an acceptable complication rate. It is easy to perform and revise, offering not only excellent and sustained weight loss outcomes during short‐term follow‐up but also the resolution or improvement of obesity‐associated comorbidities.

IBC-Oxford University2023_BJSOral_25Early outcomes of Long Biliopancreatic Limb Roux-En-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass

Abstract Background Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The one-anastomosis gastric bypass (OAGB) procedure, first introduced by Dr. Rutledge, has demonstrated a 25% greater weight loss efficiency than the traditional Roux-en-Y gastric bypass (RYGB) procedure due to the substantially longer biliopancreatic limb (BPL). Aim of the study The current work aimed to compare the outcomes of OAGB and long BPL RYGB regarding weight loss and comorbidity resolution. Patients and methods This randomized controlled trial was done at our institution between September 2019 and January 2021. Patients who were candidates for bariatric surgery were randomly and equally allocated to two groups. Group A underwent OAGB, while group B underwent long BPL RYGB. Patients were followed up for 6 months postoperatively. Results This study included 62 patients equally allocated to OAGB or long BPL RYGB, with no dropouts during follow-up. At 6 months, there was no statistically significant difference between the two groups regarding postoperative BMI (P = 0.313) and the EBWL (P = 0.238). There was comparable remission of diabetes mellitus (P = 0.708), hypertension (P = 0.999), OSA (P = 0.999), joint pain (P = 0.999), and low back pain (P = 0.999). Seven patients in the OAGB group experienced reflux symptoms (P = 0.011), which were managed by proton pump inhibitors. Conclusion Extending the BPL in RYGB provides weight loss and comorbidity remission comparable to that of OAGB. Some OAGB-related reflux cases remain a concern. However, they were sufficiently controlled with PPIs. Due to OAGB superior technical simplicity, long BPL RYGB should be preserved for cases who at higher risk for bile reflux.

Vertikaliosios skrandžio rezekcijos dešimties metų rezultatai: sisteminė literatūros apžvalga

Introduction. Sleeve gastrectomy is currently the most popular surgical treatment for obesity worldwide. However, there is still a lack of data on long-term outcomes of this procedure. The objective of this study was to review and analyze the scientific literature and evaluate the long-term (10 years and beyond) results of sleeve gastrectomy for the surgical treatment of obesity. Methods. A literature search was conducted using the PubMed search engine, resulting in 1 443 publications on the long-term results of sleeve gastrectomy for obesity. After applying search criteria and selecting articles by title and abstract, 7 results were included in the systematic review. Results. The included studies involved 2 399 patients after sleeve gastrectomy, with an average age of 41.8 years and 1 577 (65.7%) of all patients being women. The mean preoperative body mass index of the patients in the selected publications was 45.1 kg/m2. Long-term (10 years and beyond) weight loss outcomes were assessed in terms of excess body weight loss. Among the studies, the average excess body weight loss achieved was 54.2%, with a maximum of 70.5% and a minimum of 36%. Arterial hypertension remission was achieved in 23.6%, obstructive sleep apnea remission was achieved in 62.2%, type II diabetes remission was achieved in 54.4%, and dyslipidemia remission was achieved in 42.5% of patients. Conclusion. Sleeve gastrectomy provides a stable reduction in excess body weight and control of comorbidities over 10 years. However, more data on the long-term results of sleeve gastrectomy are needed to compare it with other surgical approaches in the treatment of obesity.

BS P05 The Return to Bariatric Surgery Following the COVID Pandemic 2020- A Single Center Prospective Study

Abstract Background Elective surgical practice was paused in March 2020 to cope with the Covid pandemic. Bariatric surgery was amongst the first specialities to be stopped as resource allocation prioritised lifesaving service for Covid positive patients over what is considered quality of life improving procedures. It was also one of the last to be restarted due to fears of Covid infection in obese patients undergoing surgery both of which are known risk factors of mortality in Covid cases. This study describes outcomes after bariatric surgery since the weight-loss program restarted and the measures to ensure service provision and maintenance of patient safety. Methods Elective bariatric surgery restarted in June 2021; patients were managed within a ‘green’ elective pathway in a new ring-fenced elective surgical hub. All patients who had surgery from June 2021 to January 2023 in a single centre were identified from a prospectively-maintained database of operations. The outcomes were patient safety measured by Covid infection and complication rates post operatively, impacts on hospital resources measured by length of stay in hospital and HDU/ITU bed occupation, impacts on the Bariatric Surgery service measured by waiting time for surgery and cancellations, and benefits to patients measured by remission of diabetes and hypertension. Results 124 patients were included; 42 (34%) had sleeve gastrectomy and 82 (64%) had gastric bypass. There were no Covid infections/complications in this series. Median length of stay after surgery was two days with no admissions to HDU/ICU. Waiting time for surgery was &amp;gt;52 weeks at the start of the study period which has fallen to 15 weeks after listing and no operations were cancelled due to lack of beds. Post-operative outcomes were favorable and in line with national data; 87% of patients had remission of diabetes and 60% of patients were off anti-hypertensive medications one year after surgery. Conclusions The creation of dedicated ring-fenced elective surgical hub allowed the rapid restart of bariatric surgery despite the effects of the Covid-19 pandemic. This model separated elective and acute patients reducing exposure of high-risk patients. This allowed the resumption of weight-loss surgery safely as evident by the zero Covid-related complications, no additional pressure to hospital resources such as beds and intensive care unit capacity, a high-quality service with short waiting times and favorable long term outcomes. This are all signs of good practice in a resilient service and can very easily be replicated in the future whenever required.

Bariatric surgery and blood pressure control in patients with hypertension: a systematic review and meta-analysis

Abstract Background Bariatric surgery remains the most effective method for sustained weight loss in patients with class II or III obesity. However, the effects of bariatric surgery on BP control in obese patients with hypertension are not consistent across studies. Purpose The purpose of this study was to compare the effects of bariatric surgery versus nonsurgical treatment on blood pressure control in patients with hypertension. Methods Randomized controlled trials evaluating the effects of bariatric surgery versus nonsurgical treatment on blood pressure reduction were searched in PubMed, Embase, Cochrane Database and Cochrane Clinical Trials Registry, and nineteen randomized controlled trials (in 1,375 obese patients) were finally included. The primary outcome was the rate of hypertension remission, and the follow-up periods ranged from 12 to 60 months. Results The results showed that bariatric surgery was associated with a higher hypertension remission rate (RR: 4.61, 95% CI: 2.27–9.35, P &amp;lt; 0.0001) and a greater decrease in diastolic blood pressure (WMD: -3 mmHg, 95% CI: -4.28 to -1.72, p&amp;lt;0.00001). However, no significant difference was observed in systolic blood pressure (WMD: -2.4 mmHg, 95% CI: -5.8 to 1, p=0.17). Furthermore, the following metabolic conditions and cardiovascular risk factors were also improved by bariatric surgery in patients with hypertension. Conclusion In conclusion, our study confirmed that bariatric surgery was associated with a higher rate of short-to-medium-term hypertension remission and a greater decrease in diastolic blood pressure for patients with hypertension. Bariatric surgery should be considered in these patients.

FRI143 Serum Aldosterone Levels Predict Decline In Renal Function After Unilateral Adrenalectomy For Primary Aldosteronism

Abstract Disclosure: M.A. Stumpf: None. N.L. Queiroz: None. V.C. Souza: None. A.W. Maciel: None. G.F. Fagundes: None. V. Srougi: None. F.Y. Tanno: None. J.L. Chambo: None. M.A. Pereira: None. A. Pio-Abreu: None. L.A. Bortolotto: None. A. Latronico: None. M.B. Fragoso: None. L.F. Drager: None. B.B. Mendonca: None. M.Q. Almeida: None. Background: Primary aldosteronism (PA) is a very prevalent disease, characterized by an autonomous aldosterone secretion. Unilateral PA accounts for approximately 40% of the cases and is preferentially treated with surgery. Several studies reported decrease in renal function following unilateral adrenalectomy, but the risk factors associated with this decline remain to be better elucidated. Aim: Our aim was to investigate predictive factors of the decrease in renal function after unilateral adrenalectomy for PA. Methods: We retrospectively evaluated 89 PA patients submitted to unilateral adrenalectomy. Serum aldosterone, direct renin concentration, estimated glomerular filtration rate (eGFR), and electrolytes were determined at the pre-operative period and at 1 week, 1, 3 and 6 months (m) after unilateral adrenalectomy. The primary endpoint was the DELTAeGFR (eGFR after surgery at different times – eGFR before surgery). Results: Thirty-seven patients (41.6%) were men and 52 (58.4%) were women, with a median age of diagnosis of 49 years (range, 20 to 74 years). At diagnosis, the median aldosterone and renin levels were 29.8 ng/dl (7.3 - 217) and 4 μIU/mL (4 – 8.2), respectively. Hypokalemia at diagnosis was evidenced in 75 out of 89 (84.3%) of the patients. Unilateral PA was confirmed in 78 out of 89 cases (87.6%) by biochemical cure after adrenalectomy. The mean pre-operative creatinine and eGFR were 1.14 ± 0.48 mg/dL and 53.5 ± 17.1 mL/min, respectively. After adrenalectomy, the DELTAeGFR was −6.7 ± 12.1 mL/min at 1 week (p= 0.001), 0.17 ± 10 mL/min at 1m (p= 0.91), −2 ± 8.7 mL/min at 3m (p= 0.13) and −1.8 ± 10.9 mL/min at 6m (p= 0.24). Interestingly, aldosterone levels at diagnosis were significantly associated with the DELTAeGFR at 1 week (p= 0.024). PA patients with aldosterone levels &amp;gt;50 ng/dL (n= 13) at diagnosis presented a higher deterioration in renal function at 1 week when compared to those with aldosterone &amp;lt;50 ng/dL (n= 76) (αeGFR −12 ± 8.6 mL/min vs. −5.9 ± 12.5 mL/min, respectively; p= 0.032). Moreover, the patients with hypoaldosteronism (aldosterone &amp;lt;5 ng/dl) at 1 week had a lower decrease in renal function (DELTAeGFR −4.4 ± 12mL/min (n= 41) vs. −9.9 ± 11.6 mL/min (n= 42), respectively; p= 0.014) and lower levels of aldosterone at diagnosis (31.5 ± 21.1 ng/dL vs. 50.4 ± 44.4 ng/dL, respectively; p= 0.008). The post-operative decline in renal function did not correlate with age, hypokalemia, number of anti-hypertensive medications at diagnosis, immediate pre-operative and post-operative renin, and hypertension remission after surgery. Conclusion: The renal function decreased precociously after adrenalectomy but returned to basal levels after 1m. Aldosterone levels at diagnosis and at 1 week after surgery were significantly associated with decline in renal function. Support: This work was supported by the Sao Paulo Research Foundation (FAPESP) grant 2019/15873-6. Presentation: Friday, June 16, 2023