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).
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
BACKGROUND Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. OBJECTIVES The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. METHODS We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. RESULTS A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). CONCLUSIONS Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension GATEWAY; NCT01784848).
“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.”
Schiavon et al. (Thu,) conducted a 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).