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John D. Fernstrom, PhD; Anita P. Courcoulas, MD; Patricia R. Houck, MS; Madelyn H. Fernstrom, PhD

Arch Surg. 2006;141:276-283.

Hypothesis  Systolic and diastolic pressure and the incidence of hypertension in very obese patients decline after bariatric surgery and do not rebound.

Design  Chart review.

Setting  Surgical practice in a university medical center.

Patients  Women and men, 18 years or older, with a body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) of 40 or greater, having no previous surgical intervention for extreme obesity.

Intervention  Vertical-banded gastroplasty or Roux-en-Y gastric bypass.

Main Outcome Measures  Systolic and diastolic blood pressure, BMI, and antihypertensive medications.

Results  Patients underwent Roux-en-Y gastric bypass (n = 285; mean initial BMI, 55.7) or vertical banded gastroplasty (n = 62; mean initial BMI, 48.5); half of each group was hypertensive at evaluation. The BMI dropped in both groups after surgery and stabilized at about 35 within 18 months. Systolic pressure changes were generally modest, although diastolic pressure declined significantly after surgery. In patients with untreated stage 1 hypertension, marked reductions in systolic and diastolic pressures occurred after surgery. Many patients taking antihypertensive medications before surgery discontinued them after surgery and remained normotensive.

Conclusions  Blood pressure reductions that occur after bariatric surgery and substantial weight loss depend on the blood pressure status of patients before surgery: normotensive patients and hypertensive patients taking antihypertensive medications show small postsurgical pressure reductions, while patients with elevated blood pressure before surgery show notable postsurgical pressure drops. The overall incidence of hypertension after bariatric surgery declines substantially and remains low.

Author Affiliations: Departments of Pharmacology (Dr J. D. Fernstrom), Psychiatry (Drs J. D. Fernstrom and M. H. Fernstrom and Ms Houck), and Surgery (Drs Courcoulas and M. H. Fernstrom), University of Pittsburgh School of Medicine, Pittsburgh, Pa.