Obesity is a major risk factor for hypertension and there is ample epidemiological evidence supporting the association between increased weight and increased blood pressure [36–38]. In addition, many studies have demonstrated that weight loss lowers blood pressure [39, 40]. After bariatric surgery, a decrease of 1 % in body weight leads to 1 mmHg decrease in systolic blood pressure and 2 mmHg decrease in diastolic blood pressure [41–43]. Buchwald and colleagues showed a significant reduction in hypertension in a systematic meta-analysis of 136 articles which included 22,094 patients and across all surgical procedures [8]. In particular, the percentages of patients in the total population whose hypertension resolved or improved were 61.7 % and 78.5 %, respectively.

According to a comparative study of Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes, conducted by Philip et al. on 150 patients there was a significant reduction in the number of hypertension medications after the two bariatric procedures [44]. Similarly we now have enough data on the positive effects of bariatric surgery in improvement/remission of hypertension [45–47]. Few data exist on factors associated with hypertension remission post-bariatric surgery. No information exists on factors that may actually predict hypertension relapse. Indeed, reviews of smaller surgical series have shown that normotensive or mildly hypertensive obese individuals do not achieve a significant reduction in blood pressure after gastric bypass compared with individuals with substantially elevated blood pressure [48].

As discussed above many studies have shown a drastic reduction in the use and number of antihypertensive drugs after bariatric surgery. But we have only limited data on the post-operative protocols on the usage of the different types of agents. In a recent retrospective review by Tritsch et al. on patients operated for sleeve gastrectomy at their center, the average hypertension medications reduced from 2.21 to 1.23, 1.21 and 1.18 at 1, 3 and 6 months respectively [22]. The most commonly stopped medications were thiazide diuretics. This was done to prevent volume depletion, hypotension and kidney injury. For patients with hypertension and T2DM together, a tendency to continue ACEi (Angiotensin converting enzyme inhibitors) and ARB (Angiotensin receptor blockers) was noted due to their renal protective effects. Beta blockers were continued for the benefit of perioperative beta blockade. Further changes when needed were done based on the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High blood pressure [49].

Though surgically induced, sustained weight loss does not seem to have a beneficial effect on blood pressure, it does lower pulse pressure which, is an independent predictor of coronary artery disease and cardiovascular mortality [50–52]. We hence need more data to help design post-operative hypertension management pathways. The above discussion may help design protocols and institution specific protocols have to be designed.

Dyslipidemia is one of the comorbidities associated with obesity. After bariatric surgery, dyslipidemia management is much easier. Lipid parameters typically improve after bariatric surgery, but the effects have been inconsistent and may depend on the surgical procedure performed. The effects of various surgical procedures have been discussed in detail in the section on bariatric surgery in dyslipidemia in Chap. 3. If bariatric surgery consistently improves dyslipidemia, there may be associated cost savings in lipid-modifying medications.

A comparative study, Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes, conducted on 150 patients showed that the levels of total and LDL cholesterol showed decrease and that there was a significant reduction in the number of medications needed to treat hyperlipidemia in the two surgical groups (gastric bypass and sleeve gastrectomy). Lipid-lowering drugs were required at baseline in 86 % and 78 % of patients assigned to undergo gastric bypass and sleeve gastrectomy, respectively, but use declined to 27 % and 39 % after 12 months [42].

Several series examining the effect of bariatric surgery on dyslipidemia have reported significant improvement in lipid profiles after bariatric surgery. There are marked reductions in LDL, increased HDL and decreased triglycerides [53]. In the Swedish Obesity Study significant improvements were observed in triglyceride and HDL levels at 2 and 10 years in the surgical versus the control group [54]. Although the total cholesterol was significantly different at 2 years, there was no significant difference at 10 years. However, the RYGB subgroup demonstrated significant improvements in total cholesterol, triglycerides and HDL at 10 years.

In the meta-analysis by Buchwald and colleagues, hyperlipidemia, hypercholesterolemia and hypertriglyceridemia were significantly improved across all surgical procedures at 2 year follow-up [8]. Segal et al. investigated the use of antilipemic drugs in 6235 bariatric surgery patients in a cohort study. The study reported that 59 % of the non-diabetic patients and 54 % of the diabetic patients showed a decrease in the need for the drug intake in the treatment of dyslipidemia 12 months after the surgery, thus indicating a substantial resolution of dyslipidemia after the surgical intervention [55]. Taken together, these studies suggest that bariatric surgery not only allows for sustained weight loss, but is a viable treatment option for correcting dyslipidemia in morbidly obese individuals.