Obesity Surgery

, Volume 30, Issue 1, pp 195–205 | Cite as

Changes in Central 24-h Ambulatory Blood Pressure and Hemodynamics 12 Months After Bariatric Surgery: the BARIHTA Study

  • Anna OliverasEmail author
  • Albert Goday
  • Laia Sans
  • Carlos E. Arias
  • Susana Vazquez
  • David Benaiges
  • José Manuel Ramon
  • Julio Pascual
Original Contributions



Weight loss is associated to blood pressure (BP) reduction in obese patients. There is no information on central 24-h BP changes after bariatric surgery (BS).

Methods and Results

In this study, we analyzed changes in 24-h BP 12 months following BS, with intermediate evaluations at 1, 3, and 6 months, in severely obese adults. The primary endpoint was aortic (central) 24-h systolic BP changes. Circadian BP patterns and hypertension resolution were also assessed. As secondary endpoints, we analyze changes in central 24-h diastolic BP as well as in all office and ambulatory peripheral BP parameters. Obese adults scheduled for BS as routine clinical care were recruited. We included 62 patients (39% with hypertension, 77% women, body mass index, 42.6 ± 5.5 kg/m2). Reduction in body weight was mean (IQR) 30.5% (26.2–34.4) 1 year after BS. Mean (95% CI) change in central 24-h systolic BP was − 3.1 mmHg (− 5.5 to − 0.7), p = 0.01 after adjustment for age, sex, and baseline hypertensive status. BP parameter changes were different between normotensives and hypertensives. Mean (95% CI) change in central 24-h systolic BP was − 5.2 mmHg (− 7.7 to − 2.7), p < 0.001, in normotensives and − 0.5 mmHg (− 5.1 to 4.0), p = 0.818, in hypertensives. There was a remission of hypertension in 48% of patients. Most patients had a reduced dipping pattern, similarly at baseline and 12 months after BS.


Among patients with severe obesity, there was a substantial central 24-h systolic BP decrease 12 months following BS. Importantly, this change was observed in those patients with normal BP at baseline.

Trial Registration Identifier: NCT03115502


Central blood pressure Bariatric surgery Obesity Cardiac output Arterial stiffness 



We are indebted to Sara Alvarez, Maria Vera, Berta Xargay, Anna Faura, and Tai Mooi Ho (Nephrology Dpt. Hospital del Mar and Hospital del Mar Medical Research Institute, Barcelona, Spain), for their effort and implication in the study. We are also indebted to Xavier Duran (MStat, PhD, Hospital del Mar Medical Research Institute) for his aid in performing the statistical analyses.

Source of Funding

Research reported in this publication was supported by the Spanish Society of Nephrology and by the Spanish Ministry of Health ISCIII RedinRen RD16/0009/0013. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Compliance with Ethical Standards

Conflict of Interest

All authors have completed the ICMJE uniform disclosure form and declare that they have no conflict.

Ethical Consideration

The trial was approved by the local institutional Ethic Committee in accordance with the Declaration of Helsinki, and written informed consent was obtained from all participants.

Supplementary material

11695_2019_4107_MOESM1_ESM.docx (125 kb)
ESM 1 (DOCX 124 kb)


  1. 1.
    Obesity and overweight. Fact Sheet N° 311. Geneva (Switzerland): World Health Organization 2011. Available: factsheets/fs311/en/print.html.
  2. 2.
    Kaila B, Raman M. Obesity: a review of pathogenesis and management strategies. Can J Gastroenterol. 2008;22(1):61–8.CrossRefGoogle Scholar
  3. 3.
    Ndumele CE, Matsushita K, Lazo M, et al. Obesity and subtypes of incident cardiovascular disease. J Am Heart Assoc 2016;5(8).
  4. 4.
    Murphy NF, MacIntyre K, Stewart S, et al. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study). Eur Heart J. 2006;27(1):96–106.CrossRefGoogle Scholar
  5. 5.
    Khan SS, Ning H, Wilkins JT, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280–7. Scholar
  6. 6.
    Poirier P, Cornier MA, Mazzone T, et al. American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123(15):1683–701. Scholar
  7. 7.
    Puzziferri N, Roshek 3rd TB, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312(9):934–42. Scholar
  8. 8.
    Hallersund P, Sjöström L, Olbers T, et al. 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. Scholar
  9. 9.
    Wilhelm SM, Young J, Kale-Pradhan PB. Effect of bariatric surgery on hypertension: a meta-analysis. Ann Pharmacother. 2014;48(6):674–82. Scholar
  10. 10.
    Schiavon CA, Ikeoka D, Santucci EV, et al. Effects of bariatric surgery versus medical therapy on the 24-hour ambulatory blood pressure and the prevalence of resistant hypertension. Hypertension. 2019;73(3):571–7. Scholar
  11. 11.
    O’Brien E, Parati GF, Stergiou G, et al. European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension Position Paper on Ambulatory Blood Pressure Monitoring. J Hypertens. 2013;31(9):1731–68. Scholar
  12. 12.
    van de Borne P, Watrin I, Bouquegneau M, et al. Ambulatory blood pressure and neuroendocrine control after diet-assisted gastric restrictive surgery. J Hypertens. 2000;18(3):301–6.CrossRefGoogle Scholar
  13. 13.
    Gluszewska A, Gryglewska B, Gasowski J, et al. Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension. Eur J Intern Med. 2019;60:39–45. Scholar
  14. 14.
    Pedersen JS, Borup C, Damgaard M, et al. Early 24-hour blood pressure response to Roux-en-Y gastric bypass in obese patients. Scand J Clin Lab Invest. 2017;77(1):53–9.CrossRefGoogle Scholar
  15. 15.
    Careaga M, Esmatjes E, Nuñez I, et al. Effect of weight loss on abnormal 24-hour blood pressure patterns in severely obese patients. Surg Obes Relat Dis. 2016;12(9):1719–24. Scholar
  16. 16.
    Hawkins DN, Faler BJ, Choi YU, et al. Time course of blood pressure decrease after bariatric surgery in normotensive and hypertensive patients. Obes Surg. 2018;28(7):1845–51. Scholar
  17. 17.
    McEniery CM, Cockroft JR, Roman MJ, et al. Central blood pressure: current evidence and clinical importance. Eur Heart J. 2014;35:1719–25.CrossRefGoogle Scholar
  18. 18.
    Kollias A, Lagou S, Zeniodi ME, et al. Association of central versus brachial blood pressure with target-organ damage. Systematic review and meta-analysis. Hypertension. 2016;67:183–90.CrossRefGoogle Scholar
  19. 19.
    Roman MJ, Devereux RB, Kizer JR, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007;50(1):197–203.CrossRefGoogle Scholar
  20. 20.
    Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113:1213–25.CrossRefGoogle Scholar
  21. 21.
    Vlachopoulos C, Aznaouridis K, O’Rourke MF, et al. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J. 2010;31:1865–71.CrossRefGoogle Scholar
  22. 22.
    Stergiou GS, Parati G, Vlachopoulos C, et al. Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions – position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability. J Hypertens. 2016;34:1665–77.CrossRefGoogle Scholar
  23. 23.
    van Brussel PM, van den Bogaard B, de Weijer BA, et al. Blood pressure reduction after gastric bypass surgery is explained by a decrease in cardiac output. J Appl Physiol (1985). 2017;122(2):223–9. Scholar
  24. 24.
    Franssen PM, Imholz BP. Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria. Blood Press Monit. 2010;15(4):225–8.CrossRefGoogle Scholar
  25. 25.
    Hametner B, Wassertheurer S, Kropf J, et al. Oscillometric estimation of aortic pulse wave velocity: comparison with intra-aortic catheter measurements. Blood Press Monit. 2013;18(3):173–6.CrossRefGoogle Scholar
  26. 26.
    Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008;12(4):662–7. Scholar
  27. 27.
    Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31.CrossRefGoogle Scholar
  28. 28.
    Benaiges D, Goday A, Ramon JM. et al; Obemar Group. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis. 2011;7(5):575–80. Scholar
  29. 29.
    Sjöström CD, Peltonen M, Wedel H, et al. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension. 2000;36(1):20–5.CrossRefGoogle Scholar
  30. 30.
    Chavanu K, Merkel J, Quan AM. Role of ambulatory blood pressure monitoring in the management of hypertension. Am J Health Syst Pharm. 2008;65(3):209–18. Scholar
  31. 31.
    Banegas JR, Ruilope LM, de la Sierra A, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378(16):1509–20. Scholar
  32. 32.
    Fernstrom JD, Courcoulas AP, Houck PR, et al. Long-term changes in blood pressure in extremely obese patients who have undergone bariatric surgery. Arch Surg. 2006;141(3):276–83.CrossRefGoogle Scholar
  33. 33.
    Kotsis V, Stabouli S, Papakatsika S, et al. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010;33(5):386–93. Scholar
  34. 34.
    Kotsis V, Stabouli S, Bouldin M, et al. Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension. 2005;45(4):602–7.CrossRefGoogle Scholar
  35. 35.
    Kolade OO, O'Moore-Sullivan TM, Stowasser M, et al. Arterial stiffness, central blood pressure and body size in health and disease. Int J Obes. 2012;36(1):93–9. Scholar
  36. 36.
    Harbin MM, Hultgren NE, Kelly AS, et al. Measurement of central aortic blood pressure in youth: role of obesity and sex. Am J Hypertens. 2018;31(12):1286–92. Scholar
  37. 37.
    Weisbrod RM, Shiang T, Al Sayah L, et al. Arterial stiffening precedes systolic hypertension in diet-induced obesity. Hypertension. 2013;62(6):1105–10. Scholar
  38. 38.
    Kaess BM, Rong J, Larson MG, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012;308:875–81. Scholar
  39. 39.
    Najjar SS, Scuteri A, Shetty V, et al. Pulse wave velocity is an independent predictor of the longitudinal increase in systolic blood pressure and of incident hypertension in the Baltimore Longitudinal Study of Aging. J Am Coll Cardiol. 2008;51:1377–83. Scholar
  40. 40.
    Petersen KS, Blanch N, Keogh JB, et al. Effect of weight loss on pulse wave velocity: systematic review and meta-analysis. Arterioscler Thromb Vasc Biol. 2015;35(1):243–52. Scholar
  41. 41.
    Bäckdahl J, Rydén M. Bariatric surgery helps to reduce blood pressure - insights from GATEWAY trial. Cardiovasc Res. 2018;114(3):e19–21. Scholar
  42. 42.
    Alpert MA, Omran J, Bostick BP. Effects of obesity on cardiovascular hemodynamics, cardiac morphology, and ventricular function. Curr Obes Rep. 2016;5(4):424–34.CrossRefGoogle Scholar
  43. 43.
    Reisin E, Frohlich ED, Messerli FH, et al. Cardiovascular changes after weight reduction in obesity hypertension. Ann Intern Med. 1983;98(3):315–9.CrossRefGoogle Scholar
  44. 44.
    Benas D, Kornelakis M, Triantafyllidi H, et al. Pulse wave analysis using the Mobil-O-Graph, Arteriograph and Complior device: a comparative study. Blood Press. 2019;28(2):107–13.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Hypertension Unit, Nephrology DepartmentHospital Universitari del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  2. 2.Nephrology DepartmentHospital Universitari del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  3. 3.Endocrinology DepartmentHospital Universitari del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  4. 4.Medicine DepartmentUniversitat Autònoma de Barcelona, Centro de Investigaciones Biomédicas en Red de Obesidad y NutriciónMadridSpain
  5. 5.General Surgery DepartmentHospital Universitari del Mar, Barcelona, IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain

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