Weight loss surgery provides better control of high blood pressure compared to medication

Obese people who underwent weight loss surgery were more likely to have better blood pressure control during a 1-to-5 year follow-up compared to those who had their blood pressure controlled. see high blood pressure in medicine and health care, according to the first research to be done. presented at the American Heart Association’s Hypertension Scientific Sessions 2024. The meeting, in Chicago on September 5-8, 2024, is the first scientific exchange focusing on the latest developments in basic and clinical research on hypertension blood and its relation to heart and kidney disease. , stroke, obesity and genetics.

Based on a joint analysis of data from 18 randomized controlled trials involving more than 1,300 participants, these findings confirm the positive results of previous research, the authors noted.

Our findings show that bariatric surgery is a sustainable solution for obesity-related hypertension as it results in the reduction of high blood pressure, or long-term control, while reducing dependence on medication. of blood pressure. In addition, by improving blood pressure control, bariatric surgery also reduces the risk of heart disease and improves heart health. “

Sneha Annie Sebastian, MD, lead author of the study, researcher, graduate of Azeezia Medical College in Kerala, India and resident agent from Alberta, Canada.

Bariatric surgery helps people lose weight by reducing the size of the stomach so that people feel full when they eat less and may also involve procedures that change the structure of the digestive system so that nutrients Fewer calories are consumed. According to the 2022 guidelines from the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders, bariatric surgery is recommended for people with a body mass index of 35 kg/m.² or more, regardless of the presence, absence or severity of co-morbidities.

The latest analysis, combining data from 18 randomized controlled trials in several countries, compared more than 1,300 people with obesity and high blood pressure who were randomly assigned to receive bariatric surgery or non-surgical, medical or lifestyle procedures. After an average follow-up period of 1 to 5 years, researchers found that compared to a control group, participants who underwent weight loss surgery:

• they were 2.77 times more likely to reduce their blood pressure to less than 140/90 mm Hg, defined as the elimination of blood pressure, without the need for antihypertensive medication;
• they were 7.1 times more likely to reduce their blood pressure to 130/80 mm Hg, defined as blood pressure control, while significantly reducing their use of antihypertensive medications blood;
• they lowered their systolic (top number) blood pressure, on average, 3.67 mm Hg, compared to that of the medication and lifestyle control group.

“Bariatric surgery is an effective solution for controlling obesity-related hypertension. Future research should focus on conducting long-term controlled trials with long-term follow-up and a large sample size.” growth, with more emphasis on the effects of stress, as many now focus on the effects of diabetes. In addition, it is important to evaluate the effectiveness and costs of different bariatric procedures for different patient profiles and identifying candidates for each type of surgery,” Sebastian said.

Educational, background or design information:

• The final analysis included 18 studies and 1,386 participants older than 18 years with obesity (average body weight of 38 kg/m²), with primary or secondary outcomes reporting the effects of weight loss surgery for high blood pressure. 62.7% of participants identify as female, and 37.3% identify as male.
• Studies were conducted between December 2002 and May 2024.
• People in the bariatric surgery group had many methods that make changes in the digestive system to help lose weight. People in the control group were similar in obesity and high blood pressure but were randomly selected for treatment with medication and lifestyle management instead of surgery.
• The authors included several types of weight loss surgery, however, most studies focused on Roux-en-Y gastric bypass and sleeve gastrectomy.
• Data from a group of five studies were analyzed for blood pressure reduction and medication use; four of the five studies had depression as the primary outcome. At the beginning of the four studies, participants were taking high doses of at least two antidepressants.

The analysis was limited by the differences between the trials in the basic characteristics of the participants, the surgical techniques used, how obesity was obtained and the length of follow-up. In addition, many studies did not have a large number of participants, and only 4 of the 18 studies focused on blood pressure as a primary outcome. The authors noted that these limitations may affect the generalizability and reproducibility of the results.

“These studies highlight the positive effect of weight loss on blood pressure control -; bariatric surgery has consistently improved blood pressure control in people with obesity. Unfortunately, there is data very little about the effect of weight loss surgery on the primary effect of lowering blood pressure,” said Michael E. Hall, MD, MS, FAHA, chair of the writing team for the statement. of science 2021 Association on weight loss strategies for the prevention and treatment of hypertension and chair of the department of medicine at the University of Mississippi Medical Center. Jackson, Mississippi.

“Furthermore, due to the success of new weight loss drugs and the beneficial effects on cardiometabolic conditions such as stress, we need clinical studies comparing bariatric surgery with these new drugs to make determining which people are suitable for a particular weight loss plan,” Hall said. . “Overall, bariatric surgery is an effective and durable treatment option for obesity-related hypertension.”