Bariatric Surgery Leads to Long-Term Hypertension Improvement in Patients With Obesity

Bariatric surgery may be a viable option for long-term hypertension remission in patients with obesity-related high blood pressure, according to a new report.

A study published today in Journal of the American College of Cardiology¹ shows patients with obesity and hypertension who underwent bariatric surgery achieved long-term reductions in blood pressure while taking fewer medications compared with a cohort of patients who received blood pressure medication alone.

The study authors wrote that the study shows the importance of treating obesity, a medical condition they said is often overlooked.

“As a consequence, there is a frequent failure in approaching obesity as a crucial step for mitigating the risk of important cardiovascular risk factors including hypertension, they said.

To gauge the long-term impact of bariatric surgery on hypertension, they recruited 100 people with grade 1 or 2 obesity who also had diagnosed hypertension. People with previous cardiovascular events or poorly controlled type 2 diabetes were excluded from the trial, which was named the GATEWAY (GAstric Bypass to Treat obEse Patients With steAdy hYpertension) trial.

Types of bariatric surgery

Image credit: Olivier Le Moal-stock.adobe.com

Seventy-six percent of the participants were female. The group had a mean age of 43.8 years and a mean body mass index (BMI) or 36.9 kg/m². All the patients were taking at least 2 medications. The participants were randomly assigned to receive Roux-en-Y gastric bypass (RYGB) procedures combined with medical therapy or medical therapy alone. The recruitment and follow-up period lasted from 2013 to January 2022. Follow-up took place after 5 years.

Sixty-nine patients were included in the final analysis (37 from the RYGB group and 32 from the medical therapy group). Most of the rest of the participants were lost to follow-up, although 4 patients in the RYGB group did not undergo the procedure and 1 patient in the medication-only group withdrew consent after being randomized to that group.

After 5 years, the patients in the RYGB group had a mean BMI of 28.01 kg/m² compared with 36.40 kg/m² for the medication-only group. Those who received the surgery had an 80.7% reduction in the number of medications they were taking, and 46.9% of those participants achieved hypertension remission, meaning they were able to control their blood pressure without needing medication. By comparison, the medication-only group had a modest reduction of 13.7% in the number of medications used, and only 2.4% of participants in that group achieved hypertension remission.

“In our study, we demonstrated that bariatric surgery promotes favorable and sustainable effects in several related [hypertension] parameters in subjects with obesity grades 1 and 2,” the study investigators wrote.

The authors acknowledged that much of the momentum around obesity treatment has been focused on new medications, such as semaglutide (Wegovy; Novo Nordisk), that have led to dramatic weight loss in many patients without the need for surgery. However, they said there has not yet been a randomized controlled trial looking specifically at how the newer therapies affect blood pressure over a long time horizon, and they also noted that such drugs require long-term use and come with a high cost.

They noted several limitations to their study. It was a single-center study with a relatively small sample size, and it was not powered to evaluate hard outcomes like mortality and major cardiac events.

An accompanying editorial² said the trial provides important long-term data showing the benefits for RYGB on weight loss and blood pressure.

“Further studies assessing the threshold mean body mass index vs other measures of adiposity) for bariatric surgery in people with obesity, optimal timing of bariatric surgery in obese people with cardiometabolic diseases (eg, after certain duration of obesity), type of bariatric surgery (RYGB vs sleeve gastrectomy), and comparative studies of obesity pharmacotherapies and bariatric surgery are needed to clarify the optimal treatment pathways for this common and growing disease,” they concluded.

References

1. Schiavon CA, Cavalcanti AB, Oliveira, JD, et al. Randomized trial of effect of bariatric surgery on blood pressure after 5 years. J Am Coll Cardiol. 2024;83(6):637-648. doi:10.1016/j.jacc.2023.11.032
2. Hall ME, Mace HP, Hall JE. Bariatric surgery for obesity hypertension: a gateway for durable blood pressure control. J Am Coll Cardiol. 2024;83(6):649-651. doi:10.1016/j.jacc.2023.11.033