DOI: https://doi.org/10.22141/1997-2938.3.34.2017.115736

Dynamics of daily monitoring of blood pressure in patients with morbid obesity after bariatric treatment

T.V. Kolesnik, Ya.S. Bereznitsky, R.V. Duka, R.V. Duka, E.L. Kolesnik, E.L. Kolesnik, A.A. Kosova, A.V. Nadyuk

Abstract


Background. Worldwide, obesity is declared a non-infectious epidemic of the 21st century. According to the 2016 European Guidelines on cardiovascular disease prevention (2012, 2016), overweight and obesity increase the risk of death from cardiovascular diseases and overall mortality. Obesity is one of the main risk factors for the development of hypertension. In addition, obesity is the cause of treatment-resistant or refractory arterial hypertension. The importance and priority of interventions aimed at reducing body weight, especially for the state of target organs that are affected by hypertension, was noted. If lifestyle changes to reduce body weight are not sufficient to achieve long-term results, medication and/or bariatric surgery can be the use as an addition. In recent decades, surgical methods have been widely used throughout the world to treat severe forms of obesity, and there is a clear tendency to an increase in the number of both performed surgeries and countries where bariatric surgery is becoming more common. A recent meta-analysis showed that bariatric surgery leads to a reduction in the risk of myocardial infarction, stroke, cardiovascular events, and a decrease in mortality compared to conservative therapy. The purpose of our study was to evaluate the effectiveness of blood pressure control in obese patients after bariatric treatment according to the results of daily monitoring of arterial pressure. Materials and methods. The study included 22 patients with morbid obesity. All patients were supervised by a multidisciplinary team of the staff of the Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine, which included surgeons, anaesthesiologists, cardiologists and endocrinologists. The design of the study consisted of four stages. The first stage included examination of patients according to the national guidelines and the clinical protocol “Arterial hypertension” on the provision of medical care (2012). The second stage consisted of training patients with morbid obesity and hypertension for carrying out bariatric treatment. Patients diagnosed with arterial hypertension received individually selected combined antihypertensive therapy, taking into account comorbid pathology. The efficacy of the antihypertensive therapy was assessed on the basis of an office blood pressure measurement and 24-hour blood pressure monitoring. The third stage consisted in the control of blood pressure level in all patients from the examination group and the correction of the prescribed antihypertensive therapy after bariatric treatment. Results. After surgical intervention in patients with obesity and hypertension, a significant decrease (p < 0.01) and normalization of the systolic blood pressure level for a period of 24 hours, in the day and night were established. The value of diastolic blood pressure also did not exceed the normative values during the entire measurement period, but significantly decreased only at night (p < 0.01). The level of pulse blood pressure also significantly decreased during the day and the daytime measurement period. The value of heart rate decreased during all analyzed intervals (p < 0.01). Significant positive results achieved after bariatric treatment allowed 5 (22.7 %) patients to reduce dosages at first, and then to refuse from antihypertensive therapy in view of achieving normotension, and 15 (68.2 %) patients — to reduce significantly the dosages and the number of medications. Conclusions. Weight loss as a result of surgical treatment of obesity significantly improves control of blood pressure in patients with morbid obesity, allows to reduce doses and the number of medications, not only to achieve long-term weight loss, but also to reduce the risk of serious cardiovascular events. This cohort of patients requires careful further dynamic monitoring by a multidisciplinary team of specialists.

Keywords


morbid obesity; surgical treatment; arterial hypertension

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