Weight-loss surgery proves superior to medication in managing hypertension among individuals with obesity
Individuals living with obesity who underwent weight-loss surgery demonstrated better control over their high blood pressure over a one- to five-year follow-up period when compared to those managing their hypertension through medications and lifestyle changes, according to preliminary research. This data is set to be presented at the American Heart Association’s Hypertension Scientific Sessions 2024, held in Chicago from September 5-8, 2024. This premier scientific conference focuses on the latest advances in research surrounding high blood pressure, as well as its connections to heart and kidney disease, stroke, obesity, and genetics.
The study, which conducted a combined analysis of data from 18 randomised controlled trials, involving over 1,300 participants, confirms earlier findings that weight-loss surgery can be a more effective solution than medications for managing hypertension in individuals with obesity.
“Our findings indicate that bariatric surgery is a durable solution for obesity-related hypertension as it not only leads to blood pressure remission or long-term control but also reduces dependence on antihypertensive medications. Additionally, by improving blood pressure control, bariatric surgery reduces the risk of cardiovascular disease and enhances overall heart health,” stated Dr. Sneha Annie Sebastian, lead author of the study, a researcher, and a graduate of Azeezia Medical College in Kerala, India. Dr. Sebastian is currently pursuing her residency in Alberta, Canada.
How Bariatric Surgery Works
Bariatric surgery helps individuals reduce excess weight by decreasing the size of the stomach, resulting in a sense of fullness after eating less food. Some procedures also alter the structure of the digestive system, leading to fewer nutrients and calories being absorbed by the body. 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 individuals with a body mass index (BMI) of 35 kg/m² or higher, regardless of the presence or severity of other medical conditions.
Study Findings: Bariatric Surgery and Blood Pressure Control
This new analysis involved data from 18 randomised controlled trials conducted in various countries. Over 1,300 individuals with obesity and high blood pressure were randomly assigned to either undergo bariatric surgery or follow non-surgical interventions such as medication and lifestyle adjustments. Following an average follow-up of one to five years, the researchers discovered that, in comparison to the control group, those who had weight-loss surgery:
- Were 2.77 times more likely to lower their blood pressure to below 140/90 mm Hg—referred to as blood pressure remission—without the need for antihypertensive medication.
- Were 7.1 times more likely to achieve blood pressure control of less than 130/80 mm Hg, while significantly reducing their dependence on antihypertensive medication.
- On average, they lowered their systolic blood pressure (the top number) by 3.67 mm Hg compared to those in the medication and lifestyle management group.
“Bariatric surgery is an effective solution for managing obesity-related hypertension. However, future research should concentrate on conducting large-scale randomised controlled trials with long-term follow-up, particularly focused on hypertension outcomes, as many current studies primarily examine diabetes outcomes. Furthermore, it is vital to assess the effectiveness and cost-efficiency of different bariatric procedures to identify the best candidates for each type of surgery,” added Dr. Sebastian.
Study Design and Limitations
The analysis included 18 studies with a total of 1,386 participants, all over the age of 18, who were living with obesity (average BMI of 38 kg/m²). Among them, 62.7% identified as women, and 37.3% identified as men. These studies were conducted between December 2002 and May 2024.
The participants in the bariatric surgery group underwent various types of weight-loss surgeries, with the most common being Roux-en-Y gastric bypass and sleeve gastrectomy. The control group consisted of individuals with similar obesity and high blood pressure profiles who were treated with medication and lifestyle interventions.
Data from a subgroup of five studies were specifically analysed to evaluate hypertension remission and medication usage. Four of these studies listed hypertension as the primary outcome. At the start of these studies, participants were on maximal doses of at least two blood pressure-lowering medications.
Despite the promising results, the analysis had several limitations. Differences in participant characteristics, surgical techniques, how obesity was diagnosed, and follow-up lengths among the trials may affect the generalisability of the findings. Additionally, many studies included small participant groups, and only four out of the 18 studies focused primarily on hypertension as the outcome.
“These findings highlight the profound impact that weight loss can have on blood pressure management. Bariatric surgery consistently resulted in better blood pressure control in individuals with obesity. However, there is a significant lack of data focused on surgical weight loss and hypertension remission as a primary outcome,” said Dr. Michael E. Hall, chair of the writing group for the American Heart Association’s 2021 scientific statement on weight-loss strategies for the prevention and treatment of hypertension. Dr. Hall is also the chair of the department of medicine at the University of Mississippi Medical Center in Jackson, Mississippi.
Dr. Hall further commented on the necessity of more research comparing bariatric surgery with newer weight-loss medications. “Given the effectiveness of newer weight-loss medications and their beneficial effects on cardiometabolic conditions, such as hypertension, randomised clinical studies comparing bariatric surgery to these medications are needed. This will help determine which individuals are better suited for a specific weight-loss strategy. Overall, bariatric surgery remains a highly effective and long-lasting treatment option for managing hypertension related to obesity,” he concluded.
Conclusion
This research reinforces the role of bariatric surgery as a superior method for managing hypertension in individuals living with obesity, especially compared to medication-based approaches. The study highlights the surgery’s ability to lead to blood pressure remission, reduce reliance on antihypertensive drugs, and ultimately improve heart health outcomes. However, further research is necessary to fine-tune these findings, particularly by evaluating different surgical procedures and comparing them with emerging non-surgical interventions.