Highlights
- •We studied blood pressure effects of Phentermine/Topiramate and Sleeve Gastrectomy.
- •Blood pressure improved with use of Phentermine/Topiramate with Sleeve Gastrectomy.
- •Antihypertensives were not needed with Sleeve Gastrectomy and Phentermine/Topiramate.
- •41% of patients with Sleeve Gastrectomy alone continued antihypertensive medication.
Abstract
Introduction
Management of patients with BMI≥50 kg/m2 is challenging. In previous work, pre and postoperative pharmacotherapy with phentermine/topiramate
plus laparoscopic sleeve gastrectomy (PT + SG) promoted greater weight loss than sleeve
gastrectomy (SG) alone at 24 mo postoperatively. This current secondary analysis studied
the impact of PT + SG on blood pressure (BP), heart rate, and antihypertensive usage.
Methods
Patients with BMI≥50 kg/m2 planning to have SG (n = 13) were recruited from 2014 to 2016, at an academic medical center in Winston–Salem,
North Carolina, for this open-label trial. Participants took phentermine/topiramate
(PT; 7.5/46–15/92 mg/d) for ≥3 mo preoperatively and 24 mo postoperatively. The control
group (n = 40) underwent SG during the same time frame. We used mixed models for BP and heart
rate to compare PT + SG versus SG alone over time, adjusted for age, sex, and initial BP.
Results
By 24 mo postoperatively the model adjusted changes in systolic blood pressure/diastolic
blood pressure (SBP/DBP) (mm Hg) were −24.44 (−34.46,−14.43)/−28.60 (−40.74,−16.46)
in the PT + SG group versus −11.81 (−17.58,−6.05)/−13.89 (−21.32,−6.46) in the control group (SBP P = 0.02; DBP P = 0.03). At baseline 8 (61.5%) participants in the PT + SG arm and 22 (55.0%) in
the control group used antihypertensives. Excluding patients lost to follow-up (n = 3), by 24 mo postoperatively, none of the PT + SG participants were on antihypertensives
compared to 14 (41.2%) in the control group (P = 0.01).
Conclusions
Patients with BMI≥50 kg/m2 treated with PT + SG had greater improvement in BP with no use of antihypertensive
medication at 24 mo postoperatively versus SG alone, where 41% continued medication use. Larger trials are required to evaluate
this.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
December 24,
2022
Received in revised form:
December 6,
2022
Received:
May 9,
2022
Footnotes
Vivus, Inc, the manufacturer of phentermine and topiramate extended release, provided the medication for the previously published pilot trial through an investigator-initiated trial grant.
Identification
Copyright
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