麻豆果冻传媒影音

Obese patients with hypertension who underwent bariatric surgery enjoyed a durable decrease in the medications required for them to achieve blood pressure (BP) control, according to the GATEWAY trialists.

In the 100-person study, 73% of those who had Roux-en-Y gastric bypass (RYGB) vs 11% of controls on medical therapy alone were able to achieve at least a 30% reduction in total number of antihypertensive medications while maintaining BP less than 140/90 mm Hg at 3 years (RR 6.52, 95% CI 2.50-17.03), reported researchers led by Carlos Schiavon, MD, of HCor Research Institute in São Paulo, Brazil.

Certain secondary endpoints also favored the bariatric surgery group, according to their paper in :

• Use of antihypertensives: median one vs three medications (P<0.001)

• BP control to <140/90 mm Hg without medications: 35% vs 2%

• BP control to <130/80 mm Hg without medications: 31% vs 0%

"Although a slightly higher proportion of patients in the RYGB group overall achieved BP control compared with patients in the MT [medical therapy] group, this difference did not achieve statistical significance and other measures of BP were neither statistically nor substantively different between the 2 groups," Schiavon and colleagues noted.

"Nevertheless, these results support the effective role bariatric surgery plays in reducing the burden of polypharmacy for the treatment of hypertension," the researchers concluded. "RYGB is an effective strategy for midterm BP control and hypertension remission, with fewer medications required in patients with hypertension and obesity."

Thus, GATEWAY's 3-year findings extend the 1-year results .

It should be noted that the data do not support "routine recommendation of bariatric surgery for patients with milder forms of obesity and isolated and well-controlled hypertension" nor make a case that "early intervention with bariatric surgery is necessarily better than a stepwise approach to managing the cardiometabolic consequences of obesity, particularly in patients who do not have type 2 diabetes," cautioned Annals deputy editor Christina Wee, MD, MPH, of Beth Israel Deaconess Medical Center in Boston.

Instead, bariatric surgery "may have a role for patients with milder obesity and resistant hypertension or those for whom reduction in polypharmacy is an overriding priority," she wrote in an .

"Also known as metabolic surgery, many bariatric procedures improve the of obesity, not only through weight loss but also through neurohormonal changes. Long-term observational studies suggest a 50% or greater reduction in mortality associated with bariatric surgery, particularly the RYGB procedure," said Wee.

Bariatric surgery has also been tied to .

In the trial, RYGB was performed by one surgeon at a single center in Brazil.

GATEWAY participants were made up of 100 hypertensive patients with mild-to-moderate obesity -- body mass index (BMI) of 30-39.9 -- who were receiving at least two BP-lowering medications. The cohort was 76% female, with a mean BMI of 36.9.

Exclusion criteria included BP of 180/120 mm Hg or greater, cardiovascular disease, and current smoking.

Patients were randomized to or medical therapy alone. Both groups received medical, nutritional, and psychological advice aimed at weight reduction, reduction of salt intake, and increase in potassium intake. Physical exercises were also recommended for all, according to the authors.

Bariatric surgery was associated with greater weight loss (27.8% vs -0.1% with medical therapy) and demonstrated greater improvements in the other non-BP metabolic parameters.

"We did not have any 30-day mortality or surgical morbidity in our trial; however, one patient in the RYGB group died of undetermined cause during the follow-up. Anemia is common after bariatric surgery, but it was present in both groups. was common in the RYGB group but could be potentially mitigated by better vitamin supplementation," Schiavon's team said of the adverse events observed.

Limitations of the study, the researchers said, include that it is a single-center, open-label trial. Moreover, only 88% of the RYGB group and 80% of controls completed follow-up.

Comment