A recent study published in the Journal of the American College of Cardiology highlights the effectiveness of bariatric surgery in managing hypertension, particularly in individuals with obesity and uncontrolled high blood pressure, compared to relying solely on medication. This finding is significant given the high rates of obesity and hypertension in the United States, with 41.9% and 45.4% of adults affected, respectively.
Obesity is a well-established risk factor for cardiovascular disease and plays a significant role in the development of high blood pressure, which can increase the risk of serious conditions such as heart attack, stroke, and heart failure. Despite its impact, obesity is often overlooked in clinical practice as a key contributor to cardiovascular risk factors, according to lead author Carlos Aurelio Schiavon, MD, FACS, a specialist in bariatric surgery.
The study focused on comparing the outcomes of bariatric surgery combined with medical therapy versus medical therapy alone in individuals with obesity and hypertension. The results revealed that after five years, those who underwent bariatric surgery experienced a lower BMI and required fewer medications to maintain normal blood pressure levels compared to those who relied solely on medication.
The GATEWAY trial, involving 100 participants with a BMI around 36.9 kg/m² and hypertension, demonstrated significant benefits for those who underwent bariatric surgery. These individuals experienced an 80.7% reduction in the number of medications needed, compared to only a 13.7% reduction in the medication-only group. Additionally, 46.9% of patients who underwent bariatric surgery achieved hypertension remission, defined as controlled blood pressure without medication, compared to only 2.4% in the medication-only group.
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.
"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 said.
Despite the promising findings, it's essential to acknowledge the limitations of the study, such as its single-centre design, open-label nature, and small sample size, as well as the loss of follow-up in some patients. Nevertheless, the study underscores the importance of addressing obesity as a crucial step in reducing hypertension rates and mitigating cardiovascular risk factors. Further research is needed to clarify the optimal treatment pathways for this common and growing disease.
(with ANI inputs)
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