Durable blood pressure control with bariatric surgery!

GATEWAY trial (GAstric bypass to Treat obEse Patients With steAdy hYpertension) evaluated the effect of bariatric surgery in obese persons with hypertension [1]. 100 subjects were assigned to either Roux-en-Y gastric bypass combined with medical therapy or medical therapy alone. Body mass index at 5 years was 36.40 kg/m² for the medical therapy group while it was 28.01 kg/m² for the surgical group. Remission rate of hypertension was 2.4% in the medical therapy group while it was 46.9% in the surgical group. Authors concluded that bariatric surgery is an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. There are several mechnisms by which increased adipose tissue leads to hypertension. These include impaired renal pressure natriuresis because of physical compression of the kidneys, sympathetic activity, activation of renin-angiotensin aldosterone system and insulin resistance.

Reference

1. Schiavon CA, Cavalcanti AB, Oliveira JD, Machado RHV, Santucci EV, Santos RN, Oliveira JS, Damiani LP, Junqueira D, Halpern H, Monteiro FLJ, Noujaim PM, Cohen RV, de Sousa MG, Bortolotto LA, Berwanger O, Drager LF. Randomized Trial of Effect of Bariatric Surgery on Blood Pressure After 5 Years. J Am Coll Cardiol. 2024 Feb 13;83(6):637-648. doi: 10.1016/j.jacc.2023.11.032. PMID: 38325988.