Predictive factors involving the remission and recurrence of hypertension post-laparoscopic sleeve gastrectomy in Japanese patients with severe obesity

Hideki Kumagai; Akira Sasaki; Akira Umemura; Yota Tanahashi; Takafumi Iwasaki; Taro Ando; Hirokatsu Katagiri; Hiroyuki Nitta

doi:10.1371/journal.pone.0314792

Predictive factors involving the remission and recurrence of hypertension post-laparoscopic sleeve gastrectomy in Japanese patients with severe obesity

PLoS One. 2024 Dec 17;19(12):e0314792. doi: 10.1371/journal.pone.0314792. eCollection 2024.

Authors

Hideki Kumagai¹, Akira Sasaki¹, Akira Umemura¹, Yota Tanahashi¹, Takafumi Iwasaki¹, Taro Ando¹, Hirokatsu Katagiri¹, Hiroyuki Nitta¹

Affiliation

¹ Department of Surgery, School of Medicine, Iwate Medical University, Yahaba, Iwate, Japan.

Abstract

Metabolic surgery, including laparoscopic sleeve gastrectomy (LSG), may improve hypertension (HTN) complicated by severe obesity; however, insufficient deliberation exists regarding the therapeutic effect of post-metabolic surgery on HTN. This study aimed to analyze the factors correlated with HTN remission and recurrence post-LSG in patients who have severe obesity, and to create a classification system to predict HTN remission and recurrence. Of the 102 patients who underwent LSG at Iwate Medical University Hospital between 2008 and 2020, 62 were enrolled in this study. Factors correlated with HTN remission and recurrence post-LSG were retrospectively analyzed. The HTN remission rate 12-months post-LSG was 40.3%. The remission cohort had a lower number of preoperative antihypertensive drugs (ADs) than that of the non-remission cohort (one and two tablets, respectively; p< 0.001). Additionally, the remission cohort had a statistically significantly smaller visceral fat area (VFA) than that of the non-remission cohort, at all time points. Logistic regression analysis revealed that the number of preoperative ADs and VFA were independent predictors of remission. The HTN recurrence rate 36-months post-LSG was 36.0%. In the recurrence cohort, the number of preoperative ADs and VFA were higher and larger than that in the non-recurrence cohort, respectively. Stratification, based on the number of preoperative ADs and VFA, revealed that the HTN remission and recurrence rates in the sub-cohort with a small number of preoperative ADs and small VFA (100% and 16.7%, respectively) were better than those in the sub-cohort with a large number of preoperative ADs and large VFA (5.3% and 100%, respectively). In Japanese patients with severe obesity, the number of preoperative ADs and VFA were correlated with HTN remission and recurrence post-LSG. Stratification, by combining the number of preoperative ADs and VFA, may be useful in predicting HTN remission and recurrence.

Copyright: © 2024 Kumagai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Adult
Antihypertensive Agents / therapeutic use
East Asian People
Female
Gastrectomy* / adverse effects
Gastrectomy* / methods
Humans
Hypertension* / surgery
Intra-Abdominal Fat / surgery
Japan
Laparoscopy* / methods
Male
Middle Aged
Obesity, Morbid* / surgery
Recurrence*
Remission Induction
Retrospective Studies
Treatment Outcome

Substances

Antihypertensive Agents

Grants and funding

This work was supported by JSPS KAKENHI Grant Numbers 20K11586 (Akira Sasaki), 22K11812 (Akira Umemura), 23K10852 (Akira Sasaki), and 24K20674 (Taro Ando). Research Grant from Keiryokai Grant Number 148 (Akira Umemura), and Research Grant from Chugai Pharmaceutical Co., Ltd. Grant Number CGPS20230519015 (Akira Umemura). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.