For adults with obesity and uncontrolled hypertension, bariatric surgery is an effective and durable strategy to control high blood pressure (BP), final, 5-year follow-up data from the GATEWAY trial suggested.
In the trial, those who underwent bariatric surgery had lower body mass index (BMI) and were on fewer antihypertensive medications after 5 years while maintaining normal BP than those who only used antihypertensive medications.
The results show that “bariatric and metabolic surgery can be very effective in the treatment of patients with obesity and hypertension in the long term,” chief investigator Carlos Aurelio Schiavon, MD, with the Research Institute, Heart Hospital, São Paulo, Brazil, told theheart.org | Medscape Cardiology.
“The most important clinical implication of this trial is that we must treat obesity to accomplish success when treating patients with cardiovascular diseases, such as hypertension and obesity,” Schiavon said.
The study was published online on February 5, 2024, in the Journal of the American College of Cardiology.
A Gateway to Lasting BP Control
GATEWAY enrolled 100 adults (76% women) with grade 1/2 obesity (BMI, 30 to 2; mean, 37 kg/m2) who were on at least two antihypertensive medications at maximum doses at baseline.
Half were randomly allocated to laparoscopic Roux-en-Y gastric-bypass surgery (RYGB) plus medications and half to medication alone. The primary outcome was at least a 30% reduction of antihypertensive medications while maintaining BP
After 5 years, BMI was 28.01 kg/m2 for those who had surgery vs 36.40 kg/m2 for those on medication alone (P .001).
Patients who underwent RYGB had an 80.7% reduction in the number of antihypertensive medications they were taking while maintaining BP
After 5 years, surgery patients were taking a mean of 0.80 antihypertensive medications vs 2.97 in the medication only group to control BP at or below the target.
Despite using less antihypertensive medications in the RYGB, ambulatory BP monitoring data revealed similar 24-hour, daytime, and nighttime BP profiles compared with medication alone.
The rate of hypertension remission (controlled BP without medication) was nearly 20-fold higher in the surgery group than in the medication only group (46.9% vs 2.4%; P <.001>
In addition, the rate of apparent resistant hypertension was lower with than without surgery (0% vs 15.2%). The surgery group also showed evidence of less atrial remodeling.
The 5-year results were consistent with the 1-year GATEWAY results Schiavon presented at the American Heart Association 2017 Scientific Sessions, as reported by theheart.org | Medscape Cardiology. They also mirrored the results reported at 3 years.
Limitations of the study include its single-center, open-label design with a small sample size and loss of follow-up in some patients.
“Taken together, these results support the long-term effective role of bariatric surgery in reducing the burden of hypertension and related polypharmacy, which is frequently observed in patients with obesity and is a cause of concern for them,” the authors wrote.
“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. Our results underscore the importance of approaching obesity in reducing hypertension rates,” they added.
Important Data, Lingering Questions
The coauthors of an accompanying editorial said this study provides “important long-term data on the benefits of gastric bypass on weight loss and blood pressure control, but questions remain.”
Yet, Michael Hall, MD, MSc, with University of Mississippi Medical Center in Jackson, Mississippi, and coauthors noted that the study only included patients undergoing RYGB; it remains unclear if other bariatric surgery procedures would have the same long-term results.
“Sleeve gastrectomy has become more common than RYGB because it is less complex and has earlier recovery and similar effectiveness for treating obesity and type 2 diabetes,” they pointed out. “Further comparative randomized controlled trials are needed to determine whether sleeve gastrectomy is as effective as RYGB for long-term BP control.”
As reported previously by theheart.org | Medscape Cardiology, in SLEEVEPASS, there was greater weight loss and higher likelihood of hypertension remission with RYGB than with sleeve gastrectomy (24% vs 8%; P = .04), although BP control was not the primary outcome.
The GATEWAY study was supported by a grant from Ethicon. Schiavon received a research grant from Ethicon and has received lecture fees from Ethicon and Medtronic. The editorial writers had no relevant disclosures.
Source link : https://www.medscape.com/viewarticle/weight-loss-surgery-yields-long-term-bp-control-obesity-2024a10002le?src=rss
Publish date : 2024-02-06 11:10:43
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