Patients with obesity and hypertension who undergo Roux-en-Y gastric bypass (RYGB) and receive medical therapy are significantly more likely to reduce the number of necessary antihypertensive medications by at least 30% at 3 years while maintaining blood pressure control than those managed with medical therapy alone, according to a study published in the Annals of Internal Medicine.
Investigators assessed 100 patients (aged 18-65, 76% women) with a mean body mass index of 36.9 kg/m2 and established hypertension treated with at least 2 antihypertensive drugs at maximum doses or more than 2 antihypertensive drugs at moderate doses. Participants were randomly assigned to receive either RYGB plus medical therapy or medical therapy alone. The primary outcome was achieving at least a 30% reduction in the number of antihypertensive medications and maintaining blood pressure less than 140/90 mm Hg.
Of the total cohort, 88% in the RYGB group and 80% in the medical therapy group completed follow-up. Among patients in the RYGB group, 73% achieved the primary outcome at 3 years, compared with 11% of patients in the medical therapy group (relative risk [RR] 6.52; 95% CI, 2.50-17.03; P <.001).
In addition, 35% of patients in the RYGB group and 2% of patients in the medical therapy group (1 patient who had RYGB at 24 months) achieved blood pressure less than 140/90 mm Hg without medications (RR 17.35; 95% CI, 2.34-128.62). A total of 31% of patients from the RYGB group and no patients in the medical therapy group maintained blood pressure less than 130/80 mm Hg without medications.
At 3 years, the median number of medications used was 1 (interquartile range [IQR], 0-2) in the RYGB group and 3 (IQR, 2.8-4) in the medical therapy group (P <.001).
“Bariatric surgery is an effective and durable strategy for reducing the number of antihypertensive drugs at 3 years in patients with obesity and hypertension while maintaining well-controlled blood pressure control; however, we did not demonstrate superior blood pressure control with RYGB,” the researchers commented. “Nevertheless, RYGB may be an attractive option in patients with refractory hypertension or for whom nonadherence to medical therapy and its related consequences are major concerns.”
Study limitations include the small, single-center, open-label design, and the study was not powered to adequately assess the effect of RYGB on secondary outcomes or on mortality and major cardiovascular events.
“These promising results do not minimize the potential adverse risks of bariatric surgery and the tradeoffs between cardiovascular and metabolic benefits and adverse risks and greater costs,” stated the study authors.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Schiavon CA, Bhatt DL, Ikeoka D, et al. Three-year outcomes of bariatric surgery in patients with obesity and hypertension: a randomized clinical trial [published online August 18, 2020]. Ann Intern Med. doi: 10.7326/M19-3781