By combining the number of preoperative antihypertensive drugs (ADs) and visceral fat area (VFA) may help predict hypertension (HTN) remission and recurrence post-laparoscopic sleeve gastrectomy (LSG), according to researchers from Iwate Medical University, Iwate, Japan.
The researchers sought to analyse the factors correlated with HTN remission and recurrence post-LSG in patients with severe obesity at their hospital, creating a classification system to predict HTN remission and recurrence. In total, 102 patients had LSG at Iwate Medical University Hospital, 70 were preoperatively diagnosed with HTN. Eight patients were excluded due to insufficient data, so 62 patients who had undergone a 3-year follow-up were enrolled in the study.
They analysed the variables of age, sex, weight, body mass index, excess weight loss, total weight loss, the presence or absence of recurrent weight gain, obesity-related diseases, including type 2 diabetes, obstructive sleep apnoea, dyslipidaemia and hyperuricemia, the number of ADs and the duration of HTN.
In addition, the subcutaneous fat area (SFA), VFA, plasma renin activity (PRA), plasma aldosterone concentration (PAC), creatinine, haemoglobin A1c (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of beta-cell function (HOMA-β), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid and apnoea–hypopnea index (AHI) were evaluated.
Outcomes
Of the 62 patients, 25 (40.3%) achieved HTN remission within 12 months post-LSG. The age was significantly younger (41.0- and 47.0-years-old, respectively; p=0.041). The number of preoperative ADs was statistically significantly lower (one and two tablets, respectively; p<0.001). The duration of HTN was significantly shorter (one and ten years, respectively; p<0.001) in the remission cohort than in the non-remission cohort. There was no significant difference in the incidence of obesity-related diseases between the two groups.
The non-remission cohort had a VFA and AHI that were statistically significantly greater at all time points than the remission cohort. Additionally, the VFA reduction rate in the remission cohort was significantly greater at six months post-LSG than that in the non-remission cohort (49.8 and 36.4%, respectively; p=0.004). The remission cohort had better renal function than the non-remission cohort. The effects of weight loss at six-months and 12 months post-LSG were significantly better in the remission cohort than in the non-remission cohort.
Multivariate analysis revealed that the number of ADs (odds ratio: 0.172, 95% confidence interval [CI]: 0.059–0.505, p=0.001) and VFA (odds ratio: 0.986, 95% CI: 0.972–0.999, p=0.040) were independent predictors correlated with HTN remission . In the ROC analysis, the area under the curve (AUC) value for the number of ADs was 0.889 (95% CI: 0.806–0.972), the cutoff value was one tablet, the sensitivity was 78.9%, and the specificity was 88.8%. Conversely, the AUC value for the VFA was 0.694 (95% CI: 0.558–0.830), the cut-off value was 243.0 cm2, the sensitivity was 76.5%, and the specificity was 56.0%.
Of the 25 patients who achieved HTN remission within 12 months post-LSG, 9 (36.0%) were diagnosed with recurrence within 36 months, postoperatively. The number of preoperative ADs was higher in the recurrence cohort than in the non-recurrence cohort.
Post-LSG, the recurrence cohort had lower and statistically significantly lower, preoperative HbA1c and PRA levels at 12 and 36 months, respectively, than the non-recurrence cohort. The preoperative VFA was higher in the recurrence cohort than in the non-recurrence cohort.
Differences in postoperative weight loss between the two cohorts were not observed.
In the univariate analysis, HbA1c was statistically significantly correlated with HTN recurrence. The numbers of preoperative ADs and VFA were correlated with HTN recurrence. Multivariate analysis revealed the absence of independent predictive factors for HTN recurrence.
“In this study, independent predictors of HTN recurrence could not be identified; however, in the univariate analyses, the number of preoperative ADs and VFA were correlated with HTN recurrence, the authors wrote. “Interestingly, our study revealed that HTN complicated by severe obesity was more likely to achieve remission and less likely to recur post-LSG in patients with a low number of preoperative ADs and VFA. These results should be validated by future studies, using larger sample sizes.”
The findings were reported in the paper, ‘Predictive factors involving the remission and recurrence of hypertension post-laparoscopic sleeve gastrectomy in Japanese patients with severe obesity’, published in PLOS One. To access this paper, please click here
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