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Long-term weight control after conventional diet is disappointing but may be improved when diet is assisted by gastric restrictive surgery (GRS).To determine the effects of GRS on ambulatory blood pressure (ABP) and neuroendocrine BP control in 28 morbidly obese subjects.A BP and heart rate were recorded every 10 min for 25 h before and 4 months after GRS. Effects of marked reductions in body weight on the renin-angiotensin-aldosterone system, on plasma insulin and on sympathetic activity were also determined.Body mass index decreased from 43 ± 1 to 34 ± 1 kg/m2 and systolic (S) BP decreased by 7 ± 2 mmHg during daytime (P = 0.01) and by 8 ± 3 mmHg during the night (P = 0.02). Pulse pressure, a marker of reduced arterial compliance, decreased by 5 ± 1 mmHg throughout the 24 h period (P <0.001). Diastolic BP remained unchanged. Heart rate decreased more during the night (−13 ± 2 bpm, P <0.0001) than during daytime (−5 ± 2 bpm, P = 0.03). Reductions in SBP were largest in subjects with highest initial BP values (r = 20.63, P <0.001) but were unrelated to weight loss. GRS decreased fasting glycaemia, plasma insulin, plasma C peptide and 24 h urine sodium (n = 20) and noradrenaline (n = 19) excretion (P <0.01).Diet-assisted GRS favourably affects neuroendocrine BP control in obese patients. Reductions in sodium intake, insulin levels and sympathetic tone combined with possible improvements in arterial compliance induce persistent 24 h reductions in SBP and pulse BP. Reductions in BP are largest in subjects with highest initial BP values and are unrelated to the amount of weight loss, thereby emphasizing the importance of even moderate reductions in weight on BP control.