Improvement in Hypertension (The Silent Killer)

"Hypertension" is the medical term for what the majority of people refer to as elevated blood pressure. To comprehend the significance of this common condition, a fundamental comprehension of the cardiovascular system, beginning with the heart, is required. The engine that powers the body is the heart. It circulates blood through the lungs, where oxygen is absorbed by red blood cells. The heart then distributes this oxygen-rich blood throughout the body via a network of blood vessels called arteries. As oxygen is delivered to all of the body's tissues, extensive networks of veins transport carbon dioxide back to the heart. Blood is immediately returned to the lungs, where carbon dioxide is exchanged for oxygen to complete the circuit.

Your heart beats approximately 70 times per minute on average throughout your entire existence, ensuring a steady supply of oxygen and nutrients to every part of your body. This system requires no thought on your part and continues unabated for 80, 90, or even 100 years or more, making it one of the most remarkable facets of existence.

Obviously, a variety of factors can affect the efficiency of this system, and one of the most significant is the blood pressure within the arteries. Blood may not reach certain areas, such as the brain, if your blood pressure is too low. A momentary episode of low blood pressure can induce fainting. If the blood pressure remains low for an extended period of time, it can cause shock and even mortality if vital organs are deprived of oxygen. If your blood pressure is too high, there may be few or no acute symptoms. Occasionally, patients will report a headache or pounding sensation, but high blood pressure is typically asymptomatic and, over time, can be a silent murderer.

Blood pressure is typically recorded as two numbers, such as 120 over 80, in millimeters of mercury. The first measurement is the systolic pressure, the peak pressure when the heart is actively contracting.

The heart is contracting to force blood through the arteries. The second number is the diastolic pressure, which is the minimum pressure that remains in the arteries between heartbeats.

The heart functions optimally when blood pressure is within the normal range. When the blood pressure is higher than normal, the heart must exert force against a significantly greater resistance. As the cardiac muscle enlarges to compensate, this can eventually cause pump problems. An enlarged heart is less effective and can contribute to heart failure over time.

Additionally, hypertension damages the arteries themselves. This process is known as arteriosclerosis or peripheral vascular disease. It results in a thickening of the arterial wall and a constriction of the arterial channel. It was formerly known as "hardening of the arteries," which is a fairly accurate description of what happens to these blood vessels: they become rigid. Every artery in the body is susceptible to disease, but the arteries to the heart (coronary artery disease) and brain (cerebral vascular disease) are particularly vulnerable. When these arteries become sufficiently constricted, they can cause a heart attack or a stroke.

Other factors, such as diabetes, undoubtedly contribute to the development of atherosclerosis, and when combined with hypertension, the outcome is predictable. One of the most alarming facts is that nearly three-quarters of adults with diabetes also have hypertension.

In conclusion, high blood pressure is a silent murderer. But it is not necessary. Usually, hypertension can be managed by losing weight, reducing sodium intake, and increasing physical activity. (Sound acquainted?) When these measures are ineffective, it becomes necessary to administer one or more blood pressure-lowering medications.

Obesity is a well-known and frequently significant risk factor for the development of hypertension. There have been volumes written about this association, but there is no consensus on the precise nature of their relationship. Numerous researchers believe that elevated blood pressure in obese patients is caused by excessive sodium retention by the kidneys. Simply put, this implies that obese individuals

The tendency to retain sodium and water results in elevated blood pressure. Many patients appear to have a direct correlation between adiposity and hypertension, despite the complexity of the situation.

Thus, it follows that weight loss should result in a reduction in blood pressure, which is generally the case. As is the case with diabetes, numerous articles in the medical literature support this assertion. Approximately fifty percent of patients who lose weight using the AGB experience resolution of hypertension, allowing them to discontinue all medication. Nearly three out of four conditions are either resolved or more readily managed after weight loss.

As with the improvement in diabetes, the reduction in blood pressure typically occurs quickly. The restricted diet after surgery also tends to restrict both sodium and water intake, so we closely monitor the patient's blood pressure in the hospital after surgery, then have him or her closely monitor it at home.

One patient who returned to my office one week after undergoing an AGB procedure stands out in my mind. When he entered, he appeared dreadful. He was unstable on his feet and scarcely able to stand. We brought him to the examination room and took his blood pressure. It was 80 times forty! This is bad! Initially, I envisioned a delayed operative complication, such as hemorrhaging or an infection. His abdomen was tender, and he denied experiencing discomfort. When I inquired whether he took his blood pressure medication, he responded, "Oh certainly! My doctor told me years ago that I would be required to take this medication for the remainder of my life. I explained to him that the medication was the source of the issue and that he should discontinue its use. I desired to admit him to the hospital, but he insisted on remaining at home. I persuaded him to return two days later, at which point his blood pressure was normal at 120 over 80 and he felt excellent.

This seems too wonderful to be true, correct? A surgical procedure that "cures" hypertension? Even if your blood pressure returns to normal following AGB surgery, hypertension can recur unless-

Are you prepared to proceed? you get regular exercise and consume a sensible diet. This is not advanced physics!

Improvement in Sleep Apnea

Many obese patients report being perpetually exhausted. It is simple to attribute this chronic fatigue to carrying around all those extra pounds, and that undoubtedly plays a role. However, obesity can frequently cause fatigue by disrupting sleep. Sleep apnea is quite prevalent among obese patients and is frequently the "thief in the night" that robs you of a restful night's sleep.

REM sleep, or Rapid Eye Movement sleep, is the most restful of the various stages of sleep. During this deepest phase of sleep, the body entirely relaxes, and we not only regenerate our bodies physically, but also our psyches by dreaming. Many morbidly obese people never reach this stage of sleep because as they begin to relax, their airway becomes obstructed and they cease breathing, causing them to awaken. Typically, patients are unaware of these episodes because they fall back asleep promptly. This can occur repeatedly all night long. They "wake up" fatigued in the morning and remain so throughout the day. They may become so exhausted that they fall unconscious during the day.

This condition is known medically as Pickwickian syndrome, after Joe from Charles Dickens's first popular novel, The Pickwick Papers. Joe was described as being an extremely obese young man who ate large quantities of food before falling unconscious anywhere, at any time. As carbon dioxide accumulates in their blood, patients who are so morbidly obese that they cannot walk or even get out of bed are at risk of dying from what equates to a respiratory arrest.

Snoring is closely associated with sleep apnea and extremely prevalent among obese patients; just ask their partners! As you begin to unwind and fall asleep, the tissues in your throat and nasal passages tend to collapse.

airway The pulsating flow of air through these partially obstructed passages can be loud enough to keep an entire household awake.

There have been numerous treatments for sleep apnea and snoring, including surgical excision of the throat's loose tissues. But for those who have been diagnosed with sleep apnea, the most effective treatment is frequently a breathing assist device known as a CPAP or BiPAP machine. The patient wears a mask over his or her face that exerts a small measure of positive pressure within the upper airway. This pressure keeps the passages open, facilitating the free flow of oxygen.

Once you become accustomed to donning the mask, these devices can provide significant relief from sleep apnea and snoring. Patients frequently report that the results are so dramatic that they refuse to travel without their machine. One patient stated that he will not go traveling with his family unless his CPAP machine has access to electricity. Obviously, nothing compares to a decent night's sleep.

While these instruments can provide sleep apnea relief to obese patients, weight loss surgery can also produce dramatic results. Typically, recovery follows the loss of 20 to 30 pounds. Patients report that not only are they sleeping better, but they are also hallucinating again, for many for the first time in years. However, the most frequent comment I hear after bariatric surgery is "I have so much more energy!"

Unquestionably, a portion of this increased vitality is a direct result of not having to transport around as much excess weight, but the majority of patients experience this phenomenon well before it would be expected based on their lighter load alone. Due to the fact that they are finally sleeping at night, they are waking up more rejuvenated and are able to function throughout the day without feeling chronically exhausted.

In a 2001 study of morbidly obese patients conducted by Dr. Dixon and his Australian colleagues, 59 percent of men and 45 percent of women had varied sleep disturbances prior to undergoing AGB surgery. The

cohort lost an average of 48% of their excess weight in the first year following surgery. Before surgery, 82 percent of these patients reported that snoring was a significant issue, but 12 months later, only 14 percent reported that snoring was still a problem. The prevalence of sleep apnea dropped from 33% to 2%. Daytime fatigue decreased from 39 percent to 4 percent, and only 2 percent of patients reported poor sleep quality, whereas 39 percent of patients reported poor sleep quality before surgery. It would be fascinating to see the results of a study on the sleeping patterns of their spouses, who no longer spend their evenings nudging and urging their partners to "roll over!"