Bariatric surgery improves BP control in obese, hypertensive patients

Roux-en-Y gastric bypass (RYGB) results in better midterm blood pressure (BP) control and hypertension remission, requiring fewer medications in obese and hypertensive patients, a study has shown.

The investigators randomly assigned 100 patients (mean body mass index [BMI], 36.9 kg/m²; 76 percent female) with hypertension receiving at least two medications at maximum doses or more than two medications at moderate doses and with BMI between 30.0 and 39.9 kg/m² to either RYGB plus medical therapy (MT) or MT alone.

Of the randomized participants, 88 percent from the RYGB group and 80 percent from the MT group completed follow-up. Seventy-three percent of patients from the RYGB group achieved the primary outcome of at least a 30-percent reduction in total number of antihypertensive medications while maintaining BP <140/90 mm Hg at 3 years compared with just 11 percent from the MT group (relative risk, 6.52, 95 percent confidence interval, 2.50–17.03; p<0.001).

In addition, 35 percent and 31 percent from the RYGB group compared with 2 percent and 0 percent from the MT group achieved BP <140/90 mm Hg and <130/80 mm Hg without medications, respectively.

At 3 years, the median number of medications was one (interquartile range [IQR], 0–2) in the RYGB group and three (IQR, 2.8–4) in the MT group (p<0.001). Total weight loss was 27.8 percent in the RYGB cohort and –0.1 percent in the MT cohort. Finally, 13 patients in the RYGB group developed hypovitaminosis B12 and two required reoperation.

This study was limited by its single-centre, nonblinded design.