Gastric bypass surgery is followed by lowered blood pressure and increased diuresis - long term results from the Swedish Obese Subjects (SOS) study

PLoS One. 2012;7(11):e49696. doi: 10.1371/journal.pone.0049696. Epub 2012 Nov 29.

Abstract

Objective: To compare two bariatric surgical principles with regard to effects on blood pressure and salt intake.

Background: In most patients bariatric surgery induces a sustained weight loss and a reduced cardiovascular risk profile but the long-term effect on blood pressure is uncertain.

Methods: Cohort study with data from the prospective, controlled Swedish Obese Subjects (SOS) study involving 480 primary health care centres and 25 surgical departments in Sweden. Obese patients treated with non-surgical methods (Controls, n = 1636 and n = 1132 at 2 y and 10 y follow up, respectively) were compared to patients treated with gastric bypass (GBP, n = 245 and n = 277, respectively) or purely restrictive procedures (vertical banded gastroplasty or gastric banding; VBG/B, n = 1534 and n = 1064, respectively).

Results: At long-term follow-up (median 10 y) GBP was associated with lowered systolic (mean: -5.1 mm Hg) and diastolic pressure (-5.6 mmHg) differing significantly from both VBG/B (-1.5 and -2.1 mmHg, respectively; p<0.001) and Controls (+1.2 and -3.8 mmHg, respectively; p<0.01). Diurnal urinary output was +100 ml (P<0.05) and +170 ml (P<0.001) higher in GBP subjects than in weight-loss matched VBG/B subjects at the 2 y and 10 y follow-ups, respectively. Urinary output was linearly associated with blood pressure only after GBP and these patients consumed approximately 1 g salt per day more at the follow-ups than did VBG/B (P<0.01).

Conclusions: The purely restrictive techniques VBG/B exerted a transient blood pressure lowering effect, whereas gastric bypass was associated with a sustained blood pressure reduction and an increased diuresis. The daily salt consumption was higher after gastric bypass than after restrictive bariatric surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arterial Pressure
  • Blood Pressure*
  • Body Mass Index
  • Case-Control Studies
  • Diuresis*
  • Female
  • Follow-Up Studies
  • Gastric Bypass*
  • Humans
  • Male
  • Middle Aged
  • Obesity / surgery*
  • Sodium / urine

Substances

  • Sodium

Grant support

This study received financial support by the Swedish Research Council (grant no K2010-55X-21432-01-2, K2010-55X-11285-13), the University of Gothenburg and Sahlgrenska University Hospital (ALF), the Gothenburg Medical Association, the Research Council of the Western Region of Sweden (VGR), Ethicon Endosurgery and the Swedish Foundation for Strategic Research to the Sahlgrenska Center for Cardiovascular and Metabolic Research. The SOS study is supported by grants from Hoffmann–La Roche, AstraZeneca, Cederroth, and the Swedish Medical Research Council (to Dr. L. Sjöström). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.