The role of antihypertensive therapy and bariatric surgery in achieving the pulse wave velocity target level in men with arterial hypertension and obesity
Authors: Nadiuk A , Kolesnyk T 
Published: October 2021

Abstract

Aim
To study the dynamics of pulse wave velocity (PWV) change in men with arterial hypertension (AH) and obesity depending on the treatment tactics of AH and obesity.

Materials and methods
We examined 61 middle age men with AH stage II-III (atherosclerotic plaque), which were divided into 3 groups depending on body mass index (BMI) and type of therapy: group I – 22 overweight men who received only antihypertensive therapy (AHT); group II – 22 obese men (I–III degree), who took only AHT; group III – 17 obese men (II–III degree) who received AHT and bariatric surgery (BS). The groups didn't differ in age. Combined AHT (2- and 3-component) was prescribed on the principle of preventive chronotherapy. In all groups, after 1, 3 and 6 months of AHT, the effectiveness of treatment was assessed by the dynamics of average level of blood pressure (BP) according to ABPM and the value of PWV (suprasystolic arteriography Tensiomed). We use 3 categories of PWV level: the normal and the intermediate increase levels according to the age and degree of AH (Arterial Stiffness Collaboration, 2010) and the increased level (≥10.0 m/s). Patients in group III at the 2 monthes received BS (sleeve gastrectomy or Hess-Macreau biliopancreatic diversion with duodenal switch, the volume of BS was determined by the surgeons) and continued receiving AHT like other patients.

Results
The value of BMI in groups I and II didn't change statistically after 6 months, but in group III – it decreased by 9.67 kg/m2 (p&lt;0.01). The average BP level before treatment was equal to AH grade 1 in all groups. After 6 months the target BP level according to ABPM was reached by 68.18% of patients in group I, 54.55% - in group II and 58.82% - in group III. The median of PWV before treatment in all groups was ≥10.0 m/s. (Fig. 1). According to dynamic observations, the level of PWV decreased after 1 and 3 months. After 6 months it decreased by 27.70% in group I (p=0.0001), by 13.33% in group II (p&lt;0.05) and by 29.49% in group III (p&lt;0.ehab724.23781). Evaluation of PWV according to the Arterial Stiffness Collaboration showed that before starting AHT, the number of men with different categories of PWV in the groups was comparable (Fig. 2). After 6 months of treatment in group I all patients achieved a decrease of PWV in &lt;10 m/s, 40.91% of men had an intermediate increase in PWV, and the frequency of normal PWV increased from 13.64% to 59.09%. In group II 9.09% of men still had increased level PWV and the number of men with normal PWV increased more than 4 times. In group III all patients reached the individual norma of PWV according to age and BP at the end of observation.

Conclusion
Combined AHT in all groups provides a significant decrease of PWV &lt;10 m/s. The combination of AHT and BS showed the greatest positive impact on the decrease of PWV and the achievement of individual norms according to age and BP level in all patients.

Funding Acknowledgement
Type of funding sources: None.