Bariatric Surgery Induces a Differential Effect on Plasma Aldosterone in Comparison to Dietary Advice Alone.

Background and Objectives: The pathophysiological mechanisms linking weight loss to blood pressure (BP) reduction are not completely understood. The objective of this study was to compare the effect of weight loss after Roux-en-Y gastric bypass (RYGB) on BP, renin-angiotensin-aldosterone system (RAAS), and urinary electrolytes excretion to those of dietary advice. Methods: This was a case-control prospective study including obese patients referred for RYGB (cases) and obese receiving diet advice only (controls). Ambulatory BP, plasma renin activity (PRA), plasma aldosterone concentration (PAC), and urinary electrolytes were measured before (M0) and after intervention (M3: 3 months and M12: 12 months). Results: Twenty-five patients were included in the RYGB group and twelve patients in the control group. After 12 months, weight loss (-42 ± 11.5 vs -12.3 ± 6.3 kg in the control group, p=0.001) and decrease in PAC were more pronounced in the RYGB group (-34 ± 76 vs +14 ± 45 pg/ml in the control group, p=0.002). There was no difference in PRA between both groups (-0.08 ± 1.68 vs 0.01 ± 0.37 ng/ml/h, p=0.31). Sodium excretion was more marked in the RYGB group after 3 months only (-89 ± 14.9 vs -9.9 ± 27.9 mmol/day, p=0.009). The decrease in SBP was similar between both groups (-6.9 ± 9.9 vs -7.1 ± 11.9 mmHg in the control group, p=0.96). Conclusions: Bariatric-induced weight loss induces a progressive decrease in PAC independently of PRA and sodium excretion. Whether this decrease in PAC affects target organ damage in the long term remains to be determined. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02218112.

[Severe asymptomatic hypertension and hypertensive emergency : From the ambulatory care to the emergency room]. / Hypertension artérielle sévère ou urgence hypertensive : du cabinet à l'hôpital.

High blood pressure levels are frequently encountered in medical practice, whether in an outpatient or inpatient setting. It is imperative to quickly differentiate severe hypertension associated with target organ damage, from severe hypertension without acute organ damage. In the latter situation, the management can be done on an outpatient basis by prescribing oral antihypertensive treatment with a close follow-up. On the other hand, in severe hypertension with acute target organ damage, patients should be admitted in an intensive care unit for close monitoring and, in most cases, treated with intravenous antihypertensive treatment. This article reviews the new definitions and management of these two entities and is addressed to both general practitioner and emergency doctor.

Les élévations sévères de la tension artérielle sont fréquemment rencontrées dans la pratique médicale, qu'elle soit ambulatoire ou hospitalière. Il est impératif de différencier rapidement une HTA sévère associée à un dommage d'organe(s) cible(s) d'une HTA sévère isolée. En effet, dans cette dernière situation, la prise en charge peut être gérée en ambulatoire par un traitement antihypertenseur oral tout en nécessitant un suivi rapproché par la suite. En revanche, l'HTA sévère avec atteinte aiguë d'organe(s) cible(s) nécessite une prise en charge hospitalière immédiate afin de rapidement baisser la tension artérielle à l'aide d'un traitement intraveineux. Cet article a pour but de passer en revue les nouvelles définitions et prises en charge de ces deux entités, et s'adresse autant au médecin praticien installé qu'au médecin hospitalier.