Delhi: Weight-loss surgery in obese patients can improve survival and reduce reliance on medications for high blood pressure (BP), according to two recent studies published in the journal Annals of Internal Medicine.
The first study by Carlos A. Schiavon et al determined the 3-year effects of Roux-en-Y gastric bypass (RYGB) on BP compared with medical therapy (MT) alone. In the study, 100 obese patients with hypertension or high Blood pressure in Brazil were randomized to gastric bypass plus antihypertensive medical therapy or medical therapy alone.
The primary outcome was at least a 30% reduction in the total number of antihypertensive medications while maintaining BP less than 140/90 mm Hg.
Key findings of the study include:
At 3 years, the primary outcome occurred in 73% of patients from the RYGB group compared with 11% of patients from the MT group.
Of the randomly assigned participants, 35% and 31% from the RYGB group and 2% and 0% from the MT group achieved BP less than 140/90 mm Hg and less than 130/80 mm Hg without medications, respectively.
Median (interquartile range) number of medications in the RYGB and MT groups at 3 years was 1 and 3, respectively.
Total weight loss was 27.8% and −0.1% in the RYGB and MT groups, respectively.
In the RYGB group, 13 patients developed hypovitaminosis B12 and 2 patients required reoperation.
The study concluded that -- RYGB is an effective strategy for midterm BP control and hypertension remission, with fewer medications required in patients with hypertension and obesity.
The second study by Aristithes G. Doumouras et al determined the association between bariatric surgery and all-cause mortality. In the study, 14,000 obese patients in Canada who underwent bariatric surgery (usually gastric bypass) were matched to similar patients who did not undergo the procedure.
The primary outcome was all-cause mortality, with cause-specific mortality as the secondary outcome.
Key findings of the study include:
After a median follow-up of 4.9 years, the overall mortality rate was 1.4% in the surgery group and 2.5% in the nonsurgery group.
Patients aged 55 years or older had an absolute risk reduction of 3.3%, with a lower HR of mortality in the surgery group (HR, 0.53).
Observed relative effects were similar across sex; however, the observed association in absolute terms was greater in men.
Surgery also was associated with lower cardiovascular mortality and lower cancer mortality.
The study concluded that -- Bariatric surgery was associated with substantially lower all-cause, cardiovascular, and cancer mortality. The lowered observed mortality of surgery was significant across most subgroups. The largest absolute effects were for men and patients aged 55 years or older.
References:
Three-Year Outcomes of Bariatric Surgery in Patients With Obesity and Hypertension: A Randomized Clinical Trial, DOI: https://doi.org/10.7326/M19-3781
Association Between Bariatric Surgery and All-Cause Mortality: A Population-Based Matched Cohort Study in a Universal Health Care System, DOI: https://doi.org/10.7326/M19-3925