Remission Of Hypertension Research Articles

Conversion to Roux-en-Y gastric bypass versus one-anastomosis gastric bypass after a failed primary gastric band: a matched nationwide study.

Primary laparoscopic adjustable gastric band (LAGB) has high rates of patients not achieving the desired weight loss, and it remains unclear which bariatric conversion procedure gives better results. To compare weight loss among patients undergoing conversion one-anastomosis gastric bypass (cOAGB) and conversion Roux-en-Y gastric bypass (cRYGB) after a failed LAGB. Nationwide population-based study including all 18 hospitals providing metabolic and bariatric surgery. Patients with a failed primary LAGB who underwent a cRYGB or cOAGB between January 1, 2015, and December 31, 2019, were selected from the Dutch Audit for Treatment of Obesity. The primary outcome was not achieving ≥20% total weight loss (TWL) at 1-year and up to 5-year follow-up. Secondary outcomes included postoperative complications, defined as Clavien-Dindo ≥III within 30 days, and co-morbidity remission. A propensity score matched logistic and Poisson regression model was used to estimate the difference in patients not achieving ≥20% TWL between cRYGB and cOAGB. A total of 615 (78.7%) patients underwent cRYGB, and 166 (21.3%) patients underwent cOAGB, with 163 patients successfully matched. Both groups had similar rates of patients not achieving ≥20% TWL at 1 year (odds ratio [OR] = .64, 95% confidence interval [CI]: .38-1.05). However, a sensitivity analysis showed that patients undergoing cOAGB had lower rates of patients not achieving ≥20% TWL up to 5-year follow-up (rate ratio = .69, 95% CI: .51-.95, P < .05). Patients undergoing cOAGB were less likely to achieve hypertension remission (OR = .22, 95% CI: .07-.66). There were no significant differences between groups in postoperative complications (OR = .39, 95% CI: .07-2.06, P > .05). This matched nationwide study suggests that the cOAGB has similar short-term weight loss outcomes but potentially better long-term weight loss results than cRYGB. Therefore, cOAGB could provide a reliable alternative but needs to be substantiated in future long-term studies.

Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity

Long-term results from randomized clinical trials comparing laparoscopic sleeve gastrectomy (LSG) with laparoscopic Roux-en-Y-gastric bypass (LRYGB) are limited. To compare long-term outcomes of weight loss and remission of obesity-related comorbidities and the prevalence of gastroesophageal reflux symptoms (GERD), endoscopic esophagitis, and Barrett esophagus (BE) after LSG and LRYGB at 10 years. This 10-year observational follow-up evaluated patients in the Sleeve vs Bypass (SLEEVEPASS) multicenter equivalence randomized clinical trial comparing LSG and LRYGB in the treatment of severe obesity in which 240 patients aged 18 to 60 years with median body mass index of 44.6 were randomized to LSG (n = 121) or LRYGB (n = 119). The initial trial was conducted from April 2008 to June 2010 in Finland, with last follow-up on January 27, 2021. LSG or LRYGB. The primary end point was 5-year percentage excess weight loss (%EWL). This current analysis focused on 10-year outcomes with special reference to reflux and BE. At 10 years, of 240 randomized patients (121 randomized to LSG and 119 to LRYGB; 167 women [69.6%]; mean [SD] age, 48.4 [9.4] years; mean [SD] baseline BMI, 45.9 [6.0]), 2 never underwent surgery and there were 10 unrelated deaths; 193 of the remaining 228 patients (85%) completed follow-up on weight loss and comorbidities, and 176 of 228 (77%) underwent gastroscopy. Median (range) %EWL was 43.5% (2.1%-109.2%) after LSG and 50.7% (1.7%-111.7%) after LRYGB. Mean estimate %EWL was not equivalent between the procedures; %EWL was 8.4 (95% CI, 3.1-13.6) higher in LRYGB. After LSG and LRYGB, there was no statistically significant difference in type 2 diabetes remission (26% and 33%, respectively; P = .63), dyslipidemia (19% and 35%, respectively; P = .23), or obstructive sleep apnea (16% and 31%, respectively; P = .30). Hypertension remission was superior after LRYGB (8% vs 24%; P = .04). Esophagitis was more prevalent after LSG (31% vs 7%; P < .001) with no statistically significant difference in BE (4% vs 4%; P = .29). The overall reoperation rate was 15.7% for LSG and 18.5% for LRYGB (P = .57). At 10 years, %EWL was greater after LRYGB and the procedures were not equivalent for weight loss, but both LSG and LRYGB resulted in good and sustainable weight loss. Esophagitis was more prevalent after LSG, but the cumulative incidence of BE was markedly lower than in previous trials and similar after both procedures. ClinicalTrials.gov Identifier: NCT00793143.

Remission and Relapse of Hypertension After Bariatric Surgery: A Retrospective Study on Long-Term Outcomes

The effect of Roux-en-Y gastric bypass and sleeve gastrectomy on hypertension remission and relapse has not been studied in large, multicenter studies over long periods and using clinical blood pressure (BP) measurements. This retrospective cohort study was set in Kaiser Permanente Washington, Northern California, and Southern California. Participants included 9432 patients with hypertension 21-65 years old who underwent bariatric surgery during 2005-2015 and 66,651 nonsurgical controls matched on an index date on study site, age, sex, race/ethnicity, body mass index, comorbidity burden, diabetes status, diastolic and systolic BP, and number of antihypertensive medications. At 5 years, the unadjusted cumulative incidence of hypertension remission was 60% (95% confidence interval [CI], 58-61%) among surgery patients and 14% (95% CI, 13-14%) among controls. At 1 year, the adjusted hazard ratio for the association of bariatric surgery with hypertension remission was 10.24 (95% CI, 9.61-10.90). At 5 years, the adjusted hazard ratio was 2.10 (95% CI, 1.57-2.80). Among those who remitted, the unadjusted cumulative incidence of relapse at 5 years after remission was 54% (95% CI, 51-56%) among surgery patients and 78% (95% CI 76-79%) among controls, although the adjusted hazard ratio was not significant (hazard ratio, 0.71; 95% CI, 0.46-1.08). Bariatric surgery was associated with greater hypertension remission than usual care suggesting that bariatric surgery should be discussed with patients with severe obesity and hypertension. Surgical patients who experience remission should be monitored carefully for hypertension relapse.

A CASE OF GIANT PHEOCHROMOCYTOMA

Objective: Pheochromocytomas are rare tumours originating in chromaffin cells which predominantly are located in adrenal glands They are a representation of 0.1%-1% of all cases of secondary hypertension. Pheochromocytoma is the most typical cause of hypertension by promoting hypertension remission in the majority of patients after surgical procedure. Sustained or paroxysmal hypertension is the most frequent sign of pheochromocytoma, possibly associated with the classic triad: episodic headaches, sudoresis and tachycardia. We present a case of giant right adrenal pheochromocytoma. Design and method: A 52-year-old female patient presented with nausea, vomiting, mild discomfort at right flank, headache and resistant hypertension. She had unexplained orthostatic hypotension, and could not even get out of bed Results: Her ABPM shows an optimal hypertension in 65% of measurements, and a peak of hypertension about 204/110mmHg. The CT scan of head was normal and the CT scan of the abdomen showed a heterogeneous mass lesion between the right hepatic lobe and the right kidney, with central necrosis, dimensions 90x94x93 mm, probable with the origin of the right adrenal gland. Urine catecholamines levels were high, and urine metanephrines were 3-fold higher than the normal ranges. Conclusions: After surgery, the patient discharge home with controlled BP without need for antihypertensive medication. At 1-year follow-up, she remained asymptomatic and with normal serum metanephrine values.

The Role of Ethnic Disparities in the Outcomes of Bariatric Surgery: A Systematic Review and Meta-Analysis.

Bariatric surgery is increasingly performed over the past decade for the treatment of morbid obesity. It has beneficial effects on weight reduction, along with diabetes remission. Conflicting results have been reported to evaluate the effect of ethics differences on the outcomes of bariatric surgery. We conducted this meta-analysis to outline the effects of ethnic differences on the outcomes of bariatric surgery, including weight reduction, biochemical variables, diabetes, and hypertension remission. A comprehensive literature search was conducted, using PubMed, Web of Science (ISI), Google Scholar, Popline, Global Health Library (GHL), Virtual Health Library (VHL) including Cochrane database, New York Academy of Medicine (NYAM), and System for Information on Grey Literature in Europe (SIGLE) for studies reporting body mass index (BMI), percentage of excess weight loss (%EWL), waist circumference, hypertension, lipid profile, and diabetes variables. We used the National Heart, Lung, and Blood Institute (NHLBI) tool (Bethesda, MD: NHLBI, National Institutes of Health {NIH}) for quality assessment. Comprehensive Meta-Analysis version 2 software (Englewood, NJ: Biostat, Inc.) was applied to perform the meta-analysis of the variables of interest. We included 23 studies of 71,679 subjects, who underwent bariatric surgery. The majority of the included cases were Whites 55,030 (77%), while 705 (1%) were Asians. The percentages of Blacks, African Americans, Hispanics, and Non-Hispanics were 9.3%, 1.3%, 10.4%, and 1%, respectively. BMI showed no significant difference between Whites vs African American and Hispanic vs Non-Hispanic groups (MD: 0.858; 95% CI: 3.408-1.691; p = 0.509 and MD: 0.455; 95% CI: 2.444-1.554; p = 0.663, respectively). The same result was reported for %EWL, comparing Whites vs African Americans. Lipid biochemical variables, diabetes remission, and hypertension control were significantly more seen among the Asian population. In conclusion, we reported a significant ethnic diversity and reduction in waist circumference, hyperlipidemia, and the associated morbidity one year after bariatric surgery in the Asian population. Further, high-quality prospective studies should focus on the social and psychological ethnic differences associated with obesity.

The effect of laparoscopic sleeve gastrectomy on body mass index and obesity-related diseases in patients over 50 years old

Aim of the study: Obesity is a pandemic of the 21st century and may regard people of every age. Persons after 50 years of age are a group especially exposed to severe impact of obesity which is connected, among others, with increased risk of co-morbidities. Along with age, the human body undergoes processes connected with metabolic rate decrease, accumulation of fat tissue, a physical capacity decrease which exacerbates the issue of obesity. Material and methods: Retrospective analysis of biochemical and clinical parameters was conducted in the group of 102 patients, age 50–66 years old, after sleeve gastrectomy. Results: During observation, average BMI decreased from 45.52 (41.26–50.87) kg/m2 before the surgery to 29.71 (26.08–35.42) kg/m2 one year after the surgery (p &lt; 0.001). %TWL 12 months after LSG reached 33.91% (27.81–37.6%) (p &lt; 0.001), average % EBMIL was 76.78% (58.71–93.08%). The study revealed that the most frequently coexisting diseases with obesity were: hypertension (89 patients), type 2 diabetes (39 patients), sleep apnea (27 patients), and dyslipidemia (25 patients). One year follow-up revealed remission of hypertension in 37 patients (41.57%), type 2 diabetes in 16 patients (41.02%), sleep apnea in 12 patients (44.44%), and dyslipidemia in 19 patients (76%). In patients after LSG, improvement of biochemical parameters including lipid and carbohydrate balance, as well as improvement or recovery from co-morbidities were observed. Conclusions: LSG is an efficient method of obesity treatment, especially for patients after 50 years old with co-morbidities, which leads to permanent body mass loss as well as remission or recovery from chronic diseases and improves the quality of life.

A case of atypical reninoma with mild hypertension and normal plasma renin activity but elevated plasma renin concentration

BackgroundReninoma is a rare, benign renal neoplasm. Typical clinical features include severe hypertension, secondary hyperaldosteronism, hypokalaemia and metabolic alkalosis caused by the overproduction of renin.Case presentationA 25-year-old lean Chinese woman with no family history of hypertension was hospitalized for stage 1 hypertension that gradually developed over two years. Endocrine investigation showed hyperreninemia without hyperaldosteronism and hypokalaemia. Interestingly, although the patient had an elevated plasma renin concentration (PRC), her plasma renin activity (PRA) was in the normal range. Abdominal contrast-enhanced computed tomography (CT) scanning revealed a solid, low-density, renal cortical mass with delayed enhancement. Selective renal vein sampling (SRVS) was performed, and a lateralization of the renin secretion from the left kidney was found. Enucleation of the tumour led to a rapid remission of hypertension and hyperreninemia. Based on pathological findings, the patient was diagnosed with reninoma. Immunohistochemical staining of the tumour was positive for Renin, CD34, Vimentin, and synaptophysin (Syn) and negative for somatostatin receptor 2 (SSTR2) and chromogranin A (CgA).ConclusionsReninoma can present as mild hypertension without hyperaldosteronism and hypokalaemia. The clinical features of reninoma may depend on the degree of activation of the renin-angiotensin-aldosterone system (RAAS). PRC should be incorporated in the differential diagnosis of secondary hypertension.

The impact of sleeve gastrectomy and gastric binding on weight loss and remission on comorbidities: a national registry-based study.

In recent decades, an extensive collection of research has shown various benefits of bariatric surgery in the remission of obesity-related diseases and in weight loss in patients with obesity. This study investigated whether sleeve gastrectomy (SG) or adjustable gastric banding (AGB) has the best benefit in terms of perioperative risk, weight loss, and remission of comorbidities. The German Bariatric Surgery Registry included 32,051 patients after SG and AGB. Outcome criteria were perioperative morbidity, perioperative complications, and remission of comorbidities after a one-year follow-up. Out of them 16,441 patients had completed one-year follow-up (2042 patients after AGB and 14,399 after SG). The %EWL was 40.8±23.4 for AGB and 62.4±22.6 for SG (P<0.001). BMI reduction was a significant difference in favor of SG (8.0±4.7 after AGB vs. 15.5±5.9 after SG; P<0.001). Significant differences in favor of SG were also found for remission of IDDM (P<0.001), NIDDM (P<0.001), hypertension (P<0.001), sleep apnea (P<0.001), and reflux disease (P<0.001). However, no significant difference was found between the two groups in terms of general intraoperative and general postoperative complications (P=0.809 and P=0.883, respectively). Specific postoperative complications were documented significantly more often after SG (3.4% in SG vs. 1% in AGB; P<0.001). Based on the results of our study, we can conclude that both SG and AGB can be safe surgical procedures. However, SG achieved more significant results in terms of remission of comorbidities. AGB is effective in patients without severe comorbidities and high BMI.

What patient factors influence bariatric surgery outcomes? A multiple regression analysis of Ontario Bariatric Registry data.

Background:As bariatric surgery evolves and gains popularity, statistical analysis of its outcomes could improve the process of decision-making and risk assessment. This study aimed to evaluate the influence of age and other factors on bariatric surgery outcomes in order to improve patient selection and outcomes.Methods:We analyzed data from the Ontario Bariatric Registry to evaluate the influence of age and 10 other factors on early (< 90 d) and 1-year surgical outcomes among patients aged 18 years or older who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between January 2010 and May 2013. Early outcomes included composite adverse events and readmission. The 1-year outcomes included percent excess body weight loss (%EBWL), and remission of diabetes mellitus and hypertension. We performed multiple regression analysis to identify independent variables that influenced these outcomes.Results:We identified 3166 patients (2655 women [83.9%] and 511 men [16.1%], mean age 44.8 yr, mean body mass index [BMI] 48.4) who underwent LRYGB (2839 [89.7%]) or LSG (327 [10.3%]) over the study period and completed their 1-year follow-up. Preoperative American Society of Anesthesiologists (ASA) score and history of angina were independent variables that influenced the composite adverse event outcome. Obstructive sleep apnea was the only factor that influenced early readmission. The independent factors that influenced %EBWL were age, type of surgery, BMI and baseline glycosylated hemoglobin (HbA1c) level: age was found to influence hypertension remission, and HbA1c level and obstructive sleep apnea were found to influence diabetes remission.Conclusion:Complications after bariatric surgery can be predicted by preoperative ASA score and history of angina; patient age was not related to an increase in postoperative complications. These factors could help both surgeon and patient make appropriate surgical decisions.

Long-term mortality and cardiovascular events in patients with unilateral primary aldosteronism after targeted treatments.

Long-term outcomes (especially mortality and/or major cardiovascular events (MACE)) of the unilateral primary aldosteronism (uPA) patients who underwent medical or surgery-targeted treatment, relative to those with essential hypertension (EH), have been scarcely reported. Using the prospectively designed observational Taiwan Primary Aldosteronism Investigation cohort, we identified 858 uPA cases among 1220 primary aldosteronism patients and another 1210 EH controls. Operated uPA patients were grouped via their 1-year post-therapy statuses. Primary Aldosteronism Surgical Outcome clinical complete success (hypertension remission) was achieved in 272 (49.9%) of 545 surgically treated uPA patients. After follow-up for 6.3 ± 4.0 years, both hypertension-remissive (hazard ratio (HR): 0.54; P < 0.001) and not-cured (HR: 0.61; P < 0.001) uPA patients showed a lower risk of all-cause mortality than that of EH controls; whereas the not-cured group had a higher risk of incident MACE (sub-hazard ratio (sHR), 1.41; P = 0.037) but similar atrial fibrillation (Af) and congestive heart failure (CHF). Mineralocorticoid receptor antagonist (MRA)-treated uPA patients had higher risks of MACE (sHR: 1.38; P = 0.033), Af (sHR:1.62, P = 0.049), and CHF (sHR: 1.44; P = 0.048) than those of EH controls, with mortality as a competing risk. Using inverse probability of treatment-weighted matching and counting adrenalectomy as a time-varying factor, treatment with adrenalectomy was associated with lower risks of all-cause mortality (HR: 0.57; P = 0.035), MACE (HR: 0.67; P = 0.037), and CHF (HR: 0.49; P = 0.005) compared to those of MRA therapy. Adrenalectomy, independent of post-surgical hypertension remission, was associated with lower all-cause mortality of uPA patients, compared to that of EH patients. We further documented a more beneficial effect of adrenalectomy over MRA treatment on long-term mortality, MACE, and CHF in uPA patients.

Arterial Hypertension in Morbid Obesity after Bariatric Surgery: Five Years of Follow-Up, a Before-And-After Study.

Background: Arterial hypertension (HTN) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse the prevalence and evolution of HTN and weight loss in patients suffering from morbid obesity before and after bariatric surgery, during a follow-up period of five years. Methods: A before-and-after study was carried out on severely obese patients undergoing Laparoscopic Roux-En-Y Gastric Bypass (LRYGB). Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (SBP) > 140 mmHg and/or diastolic (DBP) > 90 mmHg. HTN remission was defined as normalisation of blood pressure (BP) maintained after discontinuation of medical treatment, and HTN recurrence was considered when HTN diagnostic criteria reappeared after remission. Weight loss during the study period was evaluated for each patient, calculating excess weight loss percentage (% EWL) and BMI loss percentage (% BMIL) with reference to the baseline value. Results: A total of 273 patients were included in the study. HTN was present in 48.2%; 29.4% of hypertensive patients showed HTN remission two years after the surgical procedure, 30.3% of them had relapsed at five years. Conclusion: LRYGB in obese patients is associated with a remission of HTN, and no weight loss differences were observed between the group of patients showing HTN remission at two years and the group who did not. However, differences were observed after the second follow-up year, with an increased weight loss in the remission group, which could indicate that sustained weight loss favours the control of HTN.

Changes in Antihypertensive Medication Following Bariatric Surgery.

Obesity is a leading cause of hypertension (i.e., high blood pressure [BP]). While hypertension can be managed with antihypertensive medication, substantial weight loss can also lower BP, reducing the need for antihypertensive medication. Articles in this review (n = 60) presented data on antihypertensive medication use among adults pre- and postoperatively. Roux-en-Y gastric bypass was the most studied surgical approach followed by Laparoscopic Sleeve Gastrectomy. Antihypertensive medication was discontinued in a large proportion of patients after surgery, and the mean number of antihypertensive medications decreased by approximately one. In almost a third of the studies, over 75% of participants experienced hypertension remission. All articles aside from two reported a decrease in systolic BP, with about 40% reporting a decrease of ≥ 10mm Hg.

Hypertension Remission after Colorectal Cancer Surgery: A Single-Center Retrospective Study

The purpose of this study was to evaluate the effect of colorectal cancer surgery on hypertension. Patients who underwent colorectal cancer surgery were retrospectively enrolled. Hypertension before and 1 year after colorectal cancer surgery was recorded. As a result, eighty patients had remission of hypertension, 307 patients had no remission 1 year after colorectal cancer surgery, and the remission rate was 20.7%. In conclusion, patients with concurrent colorectal cancer and hypertension had a 20.7% remission rate 1 year after colorectal cancer surgery. Age, but not the type of surgery, was a predictive factor for the remission of hypertension.

Remission of comorbidities, weight loss, and adverse events after Sleeve Gastrectomy and Roux-en-Y gastric bypass in patients with obesity

Background: Despite the extensive literature on the outcome and impact of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on comorbidities and weight loss, clear evidence is still lacking. Our study aims to compare the short- and long-term efficacy and safety of the two procedures in patients with obesity. Methods: The primary endpoint of this retrospective registry study is to examine the adverse events after surgery, weight loss, and remission rate of comorbidities 12 months after surgery. Any result with a p-value of 5% corresponds to a significant outcome. Results: 27,882 patients had completed a one-year follow-up. 14,399 patients after SG and 13,483 after RYGB. The overall rate of intraoperative and postoperative complications was not significantly different between the two groups (overall p&gt;5%). The %EWL was 62.4% in the SG group vs. 69.2% in the RYGB group; p&lt;0.001. BMI reduction and mean weight loss were significantly different between the two groups in favor of SG. The RYGB group achieved significantly better remission of diabetes mellitus (T2DM; p&lt;0.001), hypertension (28.8% vs. 23.5%; p &lt; 0.001) and reflux 22.3% vs. 7.8%; p&lt;0.001). Sleep apnea remission was similar between the two groups (10.2%; p&lt;0.001). Conclusion: SG and RYGB are effective methods in the treatment of obesity. RYGB achieved better results in terms of remission of comorbidities and %EWL. However, further studies are needed to investigate the sustainability of weight loss and remission of comorbidities after both procedures.

Remission of comorbidities, weight loss, and adverse events after sleeve gastrectomy and Roux-en-Y Gastric Bypass in patients with obesity

Background: Despite the extensive literature on the outcome and impact of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on comorbidities and weight loss, clear evidence is still lacking. Our study aims to compare the short- and long-term efficacy and safety of the two procedures in patients with obesity. Methods: The primary endpoint of this retrospective registry study is to examine the adverse events after surgery, weight loss, and remission rate of comorbidities 12 months after surgery. Any result with a p-value of ≤ 5% corresponds to a significant outcome. Results: 27,882 patients had completed a one-year follow-up. 14,399 patients after SG and 13,483 after RYGB. The overall rate of intraoperative and postoperative complications was not significantly different between the two groups (overall p&gt;5%). The %EWL was 62.4% in the SG group vs. 69.2% in the RYGB group; p&lt;0.001. BMI reduction and mean weight loss were significantly different between the two groups in favor of SG. The RYGB group achieved significantly better remission of diabetes mellitus (T2DM; p&lt;0.001), hypertension (28.8% vs. 23.5%; p &lt; 0.001) and reflux 22.3% vs. 7.8%; p&lt;0.001). Sleep apnea remission was similar between the two groups (10.2%; p&lt;0.001). Conclusion: SG and RYGB are effective methods in the treatment of obesity. RYGB achieved better results in terms of remission of comorbidities and %EWL. However, further studies are needed to investigate the sustainability of weight loss and remission of comorbidities after both procedures.

Effects of sleeve gastrectomy versus omega-loop gastric bypass. What is best for weight loss, perioperative adverse events, and comorbidities?

Aim of the study: This study investigated whether Sleeve Gastrectomy (SG) or Omega-Loop-Gastric-Bypass (OAGB) has the best benefit in weight loss, perioperative risk, and remission of comorbidities. Methods: 29,407 patients after SG and OAGB were included in the German Bariatric Surgery Registry (GBSR). Outcome criteria were perioperative morbidity, perioperative complications, and remission of comorbidities after one year of follow-up. Results: 15,169 patients had completed 1-year follow-up (770 patients after OAGB and 14,399 after SG). The %EWL was higher for OAGB than for SG (70.4 ± 18.5 for OAGB and 62.4 ± 22.6 for SG; p&lt;0.001). BMI reduction was also a significant difference in favor of OAGB (17.5 ± 5.6 kg/m2 for OAGB vs. 15.5 ± 5.9 for SG; p&lt;0.001). There was no significant difference between the two groups in perioperative complications (p&lt;5%). Significant differences in favor of OAGB were found in remission of hypertension (p&lt;0.001), IDDM (p&lt;0.001), NIDDM (p&lt;0.001), reflux (p&lt;0.001), and sleep apnea (p&lt;0.001). Conclusion: Our analysis showed that OAGB surgery was associated with more significant BMI reduction and weight loss one year after surgery. In addition, OAGB surgery was significantly more effective in improving obesity-related comorbidities. Our results support the performance of OAGB over SG in patients with obesity and comorbidities. However, the contraindications and general condition of the patient should be considered in the context of this.

Remission, relapse, and risk of major cardiovascular events after metabolic surgery in persons with hypertension: A Swedish nationwide registry-based cohort study.

Several studies have shown that metabolic surgery is associated with remission of diabetes and hypertension. In terms of diabetes, factors such as duration, insulin use, weight loss, and age have been shown to contribute to the likelihood of remission. Such factors have not been determined for hypertension. The aim of this study was to evaluate factors associated with the remission and relapse of hypertension after metabolic surgery, as well as the risk for major adverse cardiovascular event (MACE) and mortality in patients with and without remission. All adults who underwent metabolic surgery between January 2007 and June 2016 were identified in the nationwide Scandinavian Obesity Surgery Registry (SOReg). Through cross-linkage with the Swedish Prescribed Drug Register, Patient Register, and Statistics Sweden, individual data on prescriptions, inpatient and outpatient diagnoses, and mortality were retrieved. Of the 15,984 patients with pharmacologically treated hypertension, 6,286 (39.3%) were in remission at 2 years. High weight loss and male sex were associated with higher chance of remission, while duration, number of antihypertensive drugs, age, body mass index (BMI), cardiovascular disease, and dyslipidemia were associated with lower chance. After adjustment for age, sex, BMI, comorbidities, and education, the cumulative probabilities of MACEs (2.8% versus 5.7%, adjusted odds ratio (OR) 0.60, 95% confidence interval (CI) 0.47 to 0.77, p < 0.001) and all-cause mortality (4.0% versus 8.0%, adjusted OR 0.71, 95% CI 0.57 to 0.88, p = 0.002) were lower for patients being in remission at 2 years compared with patients not in remission, despite relapse of hypertension in 2,089 patients (cumulative probability 56.3%) during 10-year follow-up. The main limitations of the study were missing information on nonpharmacological treatment for hypertension and the observational study design. In this study, we observed an association between high postoperative weight loss and male sex with better chance of remission, while we observed a lower chance of remission depending on disease severity and presence of other metabolic comorbidities. Patients who achieved remission had a halved risk of MACE and death compared with those who did not. The results suggest that in patients with severe obesity and hypertension, metabolic surgery should not be delayed.

1055 Performance of Gastric Bypass vs. Sleeve Gastrectomy in Hypertension Remission

Abstract Aim Bariatric surgery is gradually becoming a surgical field of paramount importance to global health. Our aim is to assess the performance of RYGB and SG in achieving remission of hypertension in bariatric patients. Secondarily, we aim to assess how age, gender, referral BMI, severity of hypertension, and association with T2DM, affects hypertension remission rates. Method In this observational, retrospective cohort study, we included 475 out of 505 total bariatric patients operated at the Worcestershire Royal Hospital between 2012 and 2019. Overall, 193 patients (40.6%) where taking anti-hypertensive medications pre-operatively. Hypertensive patients were divided into three categories: Mild (1 anti-hypertensive medication) 44%, moderate (2 anti-hypertensive medications) 39%, and severe (3 or more anti-hypertensive medications) 17%. All patients underwent either a RYGB 52% (101/193) or a SG 48% (92/193). We assessed hypertension remission after 1 and after 2 years. Results Hypertension remission rates post-RYGB where 40.0% after 1 year (38/95), and 43.0% (34/79) after 2 years. Rates post-SG where 40.8% after 1 year (31/76) and 43.1% (22/51) after 2 years. There was no statistically significant difference in hypertension remission rates between RYGB and SG, nor with any of secondary variable, including gender, age, BMI, severity of hypertension and association with T2DM. Conclusions Our data showed no significant difference between RYGB and SG in hypertension remission rates after 1- and 2-years post-procedure. This provides novel insights into the risk-benefit assessment of the bariatric patient, and helps define the SG as a much simpler, cheaper and safer surgical option for bariatric patients with hypertension as their major co-morbidity.

Comparison between Early Results of Laparoscopic Mini Gastric Bypass and Sleeve Gastrectomy regarding Weight Loss, Remission of Type II Diabetes Mellitus and Hypertension

Abstract Background Bariatric Surgery leads to a dramatic improvement in morbid obesity and associated type 2 Diabetes Mellitus (T2DM) and hypertension. Objectives The aim of the study was to compare between early results of Laparoscopic Mini Gastric Bypass and Sleeve gastrectomy regarding excess weight loss, remission of Type II diabetes mellitus and hypertension. Patients and Methods Type of the study, retrospective study. study setting, Our study was carried out at The General Surgery Department Ain Shams University Hospitals. study period,. All cases were operated during the period February and march 2019. Follow up of patients 6 months after operation was done (retrospective study). Last follow up was done on September 2019. The study included 50 patients aged 18-60 years with Type II Diabetes Mellitus and hypertension of at least 6 months duration, BMI 35 65 kg/m2 for at least 5 years. Results In this study There was no statistical significant difference between studied groups as regard age,gender,and baseline clinical data. there was a statistical significant difference between patients in LMGB group as well as between patients in LGS group before and six months after surgery as regard weight in kg, BMI and HbA1C and.remission of hypertention (P value 0.000). there was high statistical significant difference between studied groups as regard percentage of change of weight and BMI(P value 0.000) However, there was no statistical significant difference between studied groups as regard percent of change of HbA1C. (P value 0.613),remission of T2DM.(p value 0.123 ) and control of hypertension. (p value 0.136 ). Further results and data could be reached on long-term follow up of patients involved in this study. Conclusion Patients receiving mini-gastric bypass had more advantageous indexes than patients receiving sleeve gastrectomy, such as higher six months EWL% (excess weight loss), higher T2DM remission rate and higher hypertension remission rate. Especially on long term follow up and that was proved by meta analysis of previous studies but on short term follow up there is no statistical singnificant difference between both studied groups except in percentage of change of weight and BMI. Mini-gastric bypass is simple, safe and more effective bariatric procedure than laparoscopic sleeve gastrectomy.

Characteristics of a Novel ATP2B3 K416_F418delinsN Mutation in a Classical Aldosterone-Producing Adenoma.

Simple SummaryThe ATP2B3 channel mutation is a rare cause of primary aldosteronism (PA). ATP2B3 gene mutation leads to the dysfunction of calcium channel that pumps calcium ion out of the cell and accumulates intracellular calcium signal to stimulate aldosterone synthesis. In the present study, we found a novel somatic ATP2B3 K416_F418delinsN mutation in a PA patient, and proved its functionality by demonstrating aldosterone hyper-function in the mutant-transfected adrenal cell-line. The ATP2B3 K416_F418delinsN mutation resulted from the deletion from nucleotides 1248 to 1253. The translated amino acid sequence from 416 to 418 as lysine-phenylalanine-phenylalanine was deleted and an asparagine was inserted due to the merging of residual nucleotide sequences.In patients with primary aldosteronism (PA), the prevalence of ATP2B3 mutation is rare. The aim of this study is to report a novel ATP2B3 mutation in a PA patient. Based on our tissue bank of aldosterone-producing adenomas (APA), we identified a novel somatic ATP2B3 K416_F418delinsN mutation. The affected individual was a 53 year-old man with a 4 year history of hypertension. Computed tomography (CT) showed bilateral adrenal masses of 1.6 (left) and 0.5 cm (right) in size. An adrenal venous sampling (AVS) showed a lateralization index (LI) of 2.2 and a contralateral suppression index (CLS) of 0.12; indicating left functional predominance. After a left unilateral adrenalectomy, he achieved partial biochemical and hypertension–remission. This classical adenoma harbored a novel ATP2B3 K416_F418delinsN somatic mutation, which is a deletion from nucleotides 1248 to 1253. The translated amino acid sequence from 416 to 418, reading as lysine-phenylalanine-phenylalanine, was deleted; however, an asparagine was inserted due to merging of residual nucleotide sequences. The CYP11B2 immunohistochemistry staining demonstrated strong immunoreactivity in this classical adenoma. The ATP2B3 K416_F418delinsN mutation is a functional mutation in APA, since HAC15 cells, a human adrenal cell line, transfected with the mutant gene showed increased CYP11B2 expression and aldosterone production.