SP7.02 Bariatric surgery is superior to non-surgical intervention for the long term management of hypertension: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Aim Metabolic and bariatric surgery (MBS) may be considered for patients with a BMI of >35mkg/m2 and a significant weight related health condition. Hypertension is common in patients living with obesity, but referral to bariatric teams from hypertension clinics remain low. The aim of this study is to perform a meta-analysis of RCTs comparing surgical and non-surgical interventions for the long-term management of hypertension. Methods A database search of Medline, EMBASE, and Cochrane Library was performed to identify RCTs published between 2000-2024 comparing surgical vs non-surgical treatment outcomes for hypertension. Long-term was defined as 2 years or greater. For trials that reported multiple data points, the longest available time point was chosen. A random-effects meta-analysis model was used to compare blood pressure (BP) and hypertensive medication usage. Results 10 RCTs were identified, totalling 692 patients. Significant differences were found favouring MBS for mean systolic BP [diff -4.29 CI -6.07,-2.52, p<0.00001], mean diastolic BP [diff -2.88, CI -4.89,-0.87, p=0.005], mean changes in systolic and diastolic BP [diff -4.55, CI -6.6,-0.25, p<0.0001],[diff -3.33, CI -5.57,-1.10, p=0.004], mean number of medications per person [diff -1.38, CI -2.43,-0.33, p=0.01], mean difference in the number of medications per person [diff -1.62, CI -2.45,-0.79, p=0.0001] and the number of patients not taking medications [RR 2.12, CI 1.13,3.97, p=0.02]. Conclusion Hypertension can improve following weight loss for individuals with a BMI >35kg/m2. MBS should be considered an effective treatment for patients who have hypertension. MBS significantly improves long-term hypertension management when compared with non-surgical management.