Weight Loss Surgery May Be Most Effective For Long Term Blood Pressure Control

The latest statistical data from the CDC states that in the United States of America, the rate of obesity among adults is 41.9% and the rate of hypertension among adults is 45.4%. Obesity is a serious public health concern, so much so that it has been declared an epidemic. Obesity contributes to several potentially serious health problems such as heart disease, stroke, type 2 diabetes, certain cancers, digestive problems, sleep apnea, osteoarthritis, and fatty liver disease. 

A separate study published in Nature indicates that in America more than 40% of the obese population and more than 25% of the overweight population also have hypertension, compared to less than 15% of the normal-weight population. Obesity is a known risk factor for cardiovascular disease as well as being a major contributor to high blood pressure which can make a person more susceptible to heart attack, stroke, heart failure, and other health risks. 

"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," said Carlos Aurelio Schiavon, MD, FACS, lead author of the study and a surgeon specializing in bariatric surgery at Heart Hospital (hcor) and BP Hospital in Sao Paulo.

This study investigated the impact of treating obesity to lower high blood pressure, looking at medication adherence and bariatric surgery as long-term solutions to control obesity and as a result controlling high blood pressure. The GATEWAY Trial included 100 participants who had a BMI of around 36.9Kg/m2, with hypertension, and were taking at least two medications. Participants were assigned to either the medical therapy alone group or the Roux-en-Y gastric bypass with a medical therapy group. The primary outcome was a reduction of at least 30% antihypertensive medications while maintaining blood pressure levels less than 140/90 mmHg at a 5-year follow-up. 

According to the researchers, at the 5-year check-up, for those in the surgery group, BMI was 28.01 Kg/m2, and BMI was 36.40 Kg/m2 for those in the medication-only group. Those in the surgery group had an 80.7% reduction in the number of medications they were taking, and those in the medication-only group had a 13.7% reduction in the number of medications they were taking. Those in the surgery group had a 46.9% hypertension remission while those in the medication-only group had a hypertension remission of 2.4%; hypertension was defined as controlling blood pressure without medications. 

"Our results underscore the importance of approaching obesity in reducing hypertension rates," Schiavon said.

This study was limited by excluding those with previous cardiovascular events and those with poorly controlled type 2 diabetes from participating and being a single-center, open-label study with a small sample size, as well it was also noted that there was a loss of follow-up in some patients.

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, in an accompanying editorial comment, "Further studies assessing the threshold for bariatric surgery in people with obesity, optimal timing of bariatric surgery in obese people with cardiometabolic diseases, type of bariatric surgery and comparative studies of obesity pharmacotherapies and bariatric surgery are needed to clarify the optimal treatment pathways for this common and growing disease.”