Weight-loss surgery may help people with obesity manage high blood pressure

People with obesity who underwent weight-loss surgery were more likely to control their high blood pressure over a one to five-year period compared to those who managed their high blood pressure with medications and lifestyle management.

Based on a combined analysis of data from 18 randomised controlled trials involving more than 1,300 participants, the findings confirm the positive results from previous research.

“Our findings indicate bariatric surgery is a durable solution for obesity-related hypertension since it results in high blood pressure remission, or long-term control, while reducing the dependence on blood pressure medications,” said study lead author Sneha Annie Sebastian, M.D., a researcher, graduate of Azeezia Medical College in Kerala, India and residency candidate from Alberta, Canada.

“Additionally, by improving blood pressure control, bariatric surgery also lowers the risk of cardiovascular disease and enhances overall heart health.”

Bariatric surgery helps people lose weight by reducing the size of the stomach so people feel full when eating less and may also include procedures that change the structure of the digestive system so fewer nutrients and calories are absorbed.

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 people with a body mass index of 35 kg/m2 or higher, regardless of presence, absence or severity of co-morbidities.

The current analysis, combining data from 18 randomized controlled trials in several countries, compared more than 1,300 people with obesity and high blood pressure who were randomly selected to receive either bariatric surgery or a non-surgical, medication or lifestyle intervention.

After an average follow-up period of one to five years, the researchers found that compared to the control group, participants who had weight-loss surgery:

• Were 2.77 times more likely to lower their blood pressure to less than 140/90 mm Hg, defined as blood pressure remission, without the need for blood pressure-lowering medication;
• Were 7.1 times more likely to lower their blood pressure to less than 130/80 mm Hg, defined as blood pressure control, while substantially reducing their use of blood pressure-lowering medications;
• Lowered their systolic (top number) blood pressure by, on average, 3.67 mm Hg, compared to those in the medication and lifestyle management control group.

“Bariatric surgery is an effective solution for managing obesity-related hypertension. Future research should focus on conducting randomised controlled trials with long-term follow-up and large sample sizes, with a specific emphasis on hypertension outcomes, as many currently focus on diabetes outcomes,” Sebastian said.

“Furthermore, it is essential to evaluate the efficacy and cost-effectiveness of different bariatric procedures for various patient profiles and to identify optimal candidates for each type of surgery.”

“These findings underscore the beneficial impact of weight loss on blood pressure control — bariatric surgery consistently improved blood pressure control in individuals with obesity,” added Michael E. Hall, M.D., M.S., FAHA, chair of the writing group for the Association’s 2021 scientific statement on weight-loss strategies for prevention and treatment of hypertension and chair of the department of medicine at the University of Mississippi Medical Center in Jackson, Mississippi.

“Unfortunately, there are very limited data on the impact of surgical weight loss with the primary outcome of hypertension remission.

“Further, given the effectiveness of newer weight loss medications and beneficial effects on cardiometabolic conditions like hypertension, we need randomised clinical studies comparing bariatric surgery to these newer medications to decide which people are better suited for a specific weight-loss strategy.

“Overall, bariatric surgery is an effective and durable treatment option for hypertension related to obesity.”