Bariatric surgery more effective in controlling hypertension rates in obese patients

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Bariatric surgery is more effective than blood pressure medication alone in controlling high blood pressure or in people with high blood pressure, obesity and uncontrolled hypertension, according to a study published today. Journal of the American College of Cardiology. Those who underwent bariatric surgery had a lower BMI and took fewer medications five years later while maintaining normal blood pressure levels than those who only used antihypertensive drugs.

According to the CDC, US obesity and high blood pressure rates among adults are 41.9% and 45.4%, respectively. Obesity is a known risk factor for cardiovascular disease and a major contributor to high blood pressure, which can make a person more susceptible to heart attack, stroke, and heart failure, among other risks.

In clinical practice, obesity is a neglected condition. As a result, there is frequent failure to approach obesity as an important step in reducing the risk of important cardiovascular risk factors, including hypertension.”

Carlos Aurelio Schiavone, MD, FACS, lead author of the study and a surgeon specializing in bariatric surgery at the Heart Hospital (HCR) and BP Hospital of São Paulo.

In this study, researchers looked at the effect of obesity treatment on reducing high blood pressure. While there are new medications to treat obesity, long-term adherence to medications can be challenging. This study looks at bariatric surgery as a good long-term solution in controlling obesity and, consequently, controlling hypertension.

The GATEWAY trial included 100 subjects (76% female) with a body mass index (BMI) of approximately 36.9Kg/m.2. All participants had hypertension and were using at least two medications. Individuals with previous cardiovascular events and poorly controlled type 2 diabetes were excluded. Subjects were assigned to either Roux-en-Y gastric bypass medical therapy or medial therapy alone, and the primary outcome was at least a 30% reduction in antihypertensive medication while maintaining blood pressure levels below 140/90 mmHg at five years.

At five years, BMI was 28.01 kg/m2 those who received bariatric surgery and 36.40 kg/m2 For those undergoing treatment alone. People who had bariatric surgery had an 80.7% reduction in medications compared to a 13.7% reduction in those who used medical therapy alone. Hypertension remission, defined as controlled blood pressure without medication, was 46.9% in those who underwent bariatric surgery compared to 2.4% in those with medical therapy alone.

“Our results underscore the importance of approaching obesity in reducing hypertension rates,” Schiavone said.

Limitations of the study include that it was a single-center, open-label study with a small sample size, and some patients were lost to follow-up.

In an accompanying editorial comment, Michael Hall, MD, MSc, professor and chair of the Department of Medicine at the University of Mississippi Medical Center, said the study provides important long-term data on the benefits of gastric bypass on weight loss and blood pressure. control, but questions remain.

“Further studies evaluating the threshold for bariatric surgery in obese individuals, the optimal timing of bariatric surgery in obese individuals with cardiometabolic disease, comparative studies of bariatric surgery types and obesity pharmacotherapy, and bariatric surgery are needed to clarify this optimal treatment pathway,” he said.

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