A recent study published in the Journal of the American College of Cardiology reveals that bariatric surgery proves more effective in managing hypertension in individuals with obesity and uncontrolled high blood pressure compared to relying solely on antihypertensive medications. The research showed that individuals who underwent bariatric surgery exhibited lower BMI and required fewer medications over a five-year period while maintaining normal blood pressure levels. This outcome highlights the potential of bariatric surgery as a more impactful and sustainable intervention for those grappling with both obesity and hypertension, which are prevalent health concerns in the United States, with adult obesity and hypertension rates at 41.9% and 45.4%, respectively, according to the CDC. The study emphasizes the significant role obesity plays as a risk factor for cardiovascular disease and its contribution to high blood pressure, underscoring the potential benefits of bariatric surgery in reducing cardiovascular risks.
In light of these findings, the study suggests that bariatric surgery could serve as a valuable approach for individuals with obesity and uncontrolled hypertension, offering not only weight reduction but also a reduction in medication dependence and maintenance of healthy blood pressure levels over an extended period. Given the high prevalence of obesity and hypertension in the U.S., these results may have important implications for the management of cardiovascular health in at-risk populations.
“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,” stated 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.
The GATEWAY trial focused on assessing the impact of obesity treatment on reducing high blood pressure, recognizing the challenges of long-term medication adherence for obesity. The study, comprising 100 participants with a mean BMI of 36.9 kg/m2 and hypertension managed by at least two medications, examined the effectiveness of bariatric surgery compared to medical therapy alone. Participants were assigned to either Roux-en-Y gastric bypass with medical therapy or medical therapy alone, with the primary goal of achieving a reduction of at least 30% in antihypertensive medications while maintaining blood pressure levels below 140/90 mmHg over five years.
The results at the five-year mark revealed significant differences between the two groups. Those who underwent bariatric surgery exhibited a substantial reduction in BMI, with a remarkable 80.7% decrease in the number of medications they were taking. In contrast, the group relying solely on medical therapy experienced only a 13.7% reduction in medications. Furthermore, the remission of hypertension, defined as controlled blood pressure without medications, was notably higher in the bariatric surgery group at 46.9%, compared to a mere 2.4% in the medical therapy-only group. This underscores the potential of bariatric surgery as a more effective and lasting solution for managing obesity and, consequently, controlling high blood pressure compared to relying solely on medication.
“Our results underscore the importance of approaching obesity in reducing hypertension rates,” Schiavon stated.
The study described has several limitations that should be considered when interpreting its findings. Firstly, it is important to note that the study was a single-center, open-label trial, which may impact the generalizability of the results to a broader population. Additionally, the sample size was relatively small, consisting of 100 participants, which could affect the statistical power and the ability to draw definitive conclusions.
Another limitation mentioned is the loss of follow-up in some patients, which could introduce bias and affect the completeness of the data. In any long-term study, maintaining consistent follow-up is crucial for understanding the sustained effects of interventions, and the loss of follow-up in this study may limit the robustness of the conclusions.
In the accompanying editorial comment by Michael Hall, MD, MSc, there is a suggestion that while the study provides valuable long-term data on the benefits of gastric bypass in terms of weight loss and blood pressure control, there are remaining questions. This indicates that further research may be needed to address these questions and provide a more comprehensive understanding of the implications and generalizability of the study’s findings.
“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,” he stated.
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