Bariatric surgery and blood pressure control in patients with hypertension: a systematic review and meta-analysis

Background Bariatric surgery remains the most effective method for sustained weight loss in patients with class II or III obesity. However, the effects of bariatric surgery on BP control in obese patients with hypertension are not consistent across studies. Purpose The purpose of this study was to compare the effects of bariatric surgery versus nonsurgical treatment on blood pressure control in patients with hypertension. Methods Randomized controlled trials evaluating the effects of bariatric surgery versus nonsurgical treatment on blood pressure reduction were searched in PubMed, Embase, Cochrane Database and Cochrane Clinical Trials Registry, and nineteen randomized controlled trials (in 1,375 obese patients) were finally included. The primary outcome was the rate of hypertension remission, and the follow-up periods ranged from 12 to 60 months. Results The results showed that bariatric surgery was associated with a higher hypertension remission rate (RR: 4.61, 95% CI: 2.27–9.35, P < 0.0001) and a greater decrease in diastolic blood pressure (WMD: -3 mmHg, 95% CI: -4.28 to -1.72, p<0.00001). However, no significant difference was observed in systolic blood pressure (WMD: -2.4 mmHg, 95% CI: -5.8 to 1, p=0.17). Furthermore, the following metabolic conditions and cardiovascular risk factors were also improved by bariatric surgery in patients with hypertension. Conclusion In conclusion, our study confirmed that bariatric surgery was associated with a higher rate of short-to-medium-term hypertension remission and a greater decrease in diastolic blood pressure for patients with hypertension. Bariatric surgery should be considered in these patients.