Abstract
Hypertension, diabetes, and obesity frequently coexist and significantly contribute to cardiovascular morbidity and mortality. Weight loss in obese individuals has been associated with improved blood pressure control and regression in left ventricular (LV) hypertrophy. The authors investigated the impact of comorbidity and medication on clinical and echocardiographic parameters after weight loss in obese patients. Serial echocardiography and clinical data were collected in 62 patients before bariatric surgery and after 6 months or 10% weight loss. Obese patients with diabetes or hypertension had higher baseline LV mass (LVM) (334 + or - 73 g in hypertension and diabetes vs 252 + or - 97 g in hypertension and 219 + or - 75 g in disease-free patients, P = .003; P = .089 for differences in LVM indexed by height), despite the lack of significant differences in body mass index or systolic blood pressure. There were no significant differences in baseline LVM or LVM index related to the medication used to treat hypertension. After weight loss, patients on beta-blocker therapy experienced the most significant LV hypertrophy regression (-76.5 + or - 79.1 g with beta-blockers, -17.8 + or - 43.7 g with diuretics, -4.5 + or - 46.6 g with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and -23.1 + or - 50.9 g in not treated patients, overall P = .538; beta-blockers vs no therapy P < .005; P = .145 for differences in LVM index). Bariatric surgery, combined with a weight loss program, provide substantial weight and LVM reduction regardless of comorbidities or blood pressure changes. beta-Blocker therapy appears to be associated with the greatest LVM regression after weight loss.