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Ambulatory blood pressure and neuroendocrine control after diet-assisted gastric restrictive surgery

van de Borne, Philippe1,4; Watrin, Isabelle1,2,3; Bouquegneau, Marie2; Gilles, Axelles1; Houben, Jean-Jaques3; Fery, Françoise2; Degaute, Jean Paul1

Original article

Background Long-term weight control after conventional diet is disappointing but may be improved when diet is assisted by gastric restrictive surgery (GRS).

Objective To determine the effects of GRS on ambulatory blood pressure (ABP) and neuroendocrine BP control in 28 morbidly obese subjects.

Methods A BP and heart rate were recorded every 10 min for 25 h before and 4 months after GRS. Effects of marked reductions in body weight on the renin-angiotensin-aldosterone system, on plasma insulin and on sympathetic activity were also determined.

Results Body mass index decreased from 43 ± 1 to 34 ± 1 kg/m2 and systolic (S) BP decreased by 7 ± 2 mmHg during daytime (P = 0.01) and by 8 ± 3 mmHg during the night (P = 0.02). Pulse pressure, a marker of reduced arterial compliance, decreased by 5 ± 1 mmHg throughout the 24 h period (P <0.001). Diastolic BP remained unchanged. Heart rate decreased more during the night (−13 ± 2 bpm, P <0.0001) than during daytime (−5 ± 2 bpm, P = 0.03). Reductions in SBP were largest in subjects with highest initial BP values (r = 20.63, P <0.001) but were unrelated to weight loss. GRS decreased fasting glycaemia, plasma insulin, plasma C peptide and 24 h urine sodium (n = 20) and noradrenaline (n = 19) excretion (P <0.01).

Conclusions Diet-assisted GRS favourably affects neuroendocrine BP control in obese patients. Reductions in sodium intake, insulin levels and sympathetic tone combined with possible improvements in arterial compliance induce persistent 24 h reductions in SBP and pulse BP. Reductions in BP are largest in subjects with highest initial BP values and are unrelated to the amount of weight loss, thereby emphasizing the importance of even moderate reductions in weight on BP control.

1Hypertension Clinic, Erasme Hospital, Brussels, Belgium

2Department of Endocrinology, Erasme Hospital, Brussels, Belgium

3Department of Gastric Surgery, Erasme Hospital, Brussels, Belgium.

4Correspondence and requests for reprints to Philippe van de Borne, MD, PhD, Hypertension Clinic, Department of Cardiology, Erasme Hospital, 808 Lennik Road, 1070 Brussels, Belgium.

Tel: +32 2 555 3381; fax: +32 2 555 6713; e-mail:

Sponsorship: This study was supported by the Belgian National Fund for Research, a 3M Pharma Grand in Aid, and a Bekales Research Award.

Received 5 May 1999 Revised 30 November 1999 Accepted 20 December 1999

© 2000 Lippincott Williams & Wilkins, Inc.