Evidence Matters

Is Bariatric Surgery Associated with a Lower Rate of Hypertension Remission 5 Years Post-Surgery?

BACKGROUND AND PURPOSE:

Schiavon et al. (Journal of the American College of Cardiology, 2024) assessed the long-term effects of bariatric surgery on hypertension control and remission

5-year follow-up of randomized clinical trial
Participants
- Obesity grade 1 or 2
- Hypertension using ≥2 medications
- Exclusions: History of cardiovascular events | Poorly controlled type 2 diabetes
Interventions
- Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT)
- MT alone
Study design
- Outcomes were reassessed 5 years after the primary analysis
- Analysis was by intention-to-treat
Primary outcome
- Reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg

100 participants
- Mean age: 43.8 (SD, 9.2) years | Women: 76%
- Mean BMI at recruitment: 36.9 (SD, 2.7) kg/m2
At 5 years, BMI was lower for RYGB compared to MT alone (P<0.001)
- MT alone: 36.40 kg/m2 (95% CI, 35.28 to 37.52)
- RYGB: 28.01 kg/m2 (95% CI, 26.95 to 29.08)
Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (P<0.001)
- MT alone: 13.7% | RYGB: 80.7%
- RR 5.91 (95% CI, 2.58 to 13.52)
At 5 years, the mean number of antihypertensive medications was lower for the RYGB group (P<0.001)
- MT alone: 2.97 (95% CI, 2.33 to 3.60)
- RYGB: 0.80 (95% CI, 0.51 to 1.09)
Rates of hypertension remission were also lower in the RYGB group (P<0.001)
- MT alone: 46.9% | RYGB: 2.4%
- RR 19.66 (95% CI, 2.74 to 141.09)
Results were consistent when considering only completed cases
The rate of apparent resistant hypertension was lower after RYGB
- MT alone: 15.2% | RYGB: 0%

For patients with obesity, bariatric surgery reduces long-term BMI and rates of hypertension
Bariatric surgery also reduces the number of antihypertensive medications required for treatment long term