Key result
Roux-en-Y gastric bypass plus medical therapy significantly increased the rate of ≥30% reduction in antihypertensive medications compared to medical therapy alone (80.7% vs 13.7%; RR 5.91; P<0.001).
Why the study?
Obesity is a major obstacle for controlling hypertension, and the long-term effects of bariatric surgery on hypertension control and remission needed to be determined.
RCT (n=100)
Relative Risk: 5.91 (95% CI 2.58–13.52)
Absolute Event Rate: 80.7% vs 13.7%
p-value: p=< 0.001
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In clinical practice, obesity is an overlooked condition. 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.”
“The 5-year results are extremely important because they show the durability of bariatric surgery beyond that first year or two when there is significant weight loss. The effect is well sustained in terms of improving blood pressure control. I think one of the key findings in this study was that surgery was very effective for those with resistant hypertension. It basically resolved the problem whereas with medical therapy, there was still a significant number of people who were on three drugs or more that were still not at their target diastolic and systolic blood pressure.”
“While those results are impressive, the results related to hypertension are equally as impressive, as we see in this study. The results replicate findings from other, larger investigations from around the world as well. What may get lost in the shuffle is that as people continue to age, as they maybe become a little less active with age, and as they move further away from the date of surgery, it could be that their blood pressure actually gets a little less attention and could, in fact, start to creep up again. To see the rates of remission and improvement stay as robust as they are in this study is really encouraging.”
Supports bariatric surgery for sustained BP control in obese patients; extends RCT evidence to 5-year outcomes.
Schiavon et al. (2024) conducted an RCT in Obesity grade 1 or 2 plus hypertension (n=100). Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) vs. Medical therapy (MT) alone was evaluated on Reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg (RR 5.91, 95% CI 2.58-13.52, p=< 0.001). Roux-en-Y gastric bypass plus medical therapy significantly increased the rate of ≥30% reduction in antihypertensive medications compared to medical therapy alone (80.7% vs 13.7%; RR 5.91; P<0.001).
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