New GATEWAY data: Hypertension remission, fewer BP meds 5 years after bariatric surgery
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Key takeaways:
- Adults with obesity used fewer antihypertensive medications at 5 years after bariatric surgery vs. medical therapy.
- Bariatric surgery was associated with a 20-fold higher likelihood for hypertension remission.
Adults with obesity plus hypertension used fewer BP-lowering medications and were much more likely to experience hypertension remission 5 years after undergoing bariatric surgery compared with medical therapy alone, researchers reported.
The final 5-year data from the GATEWAY trial — the only randomized controlled trial to compare bariatric surgery with medical therapy for BP reduction, use of antihypertensive medications and hypertension remission in people with obesity — published in the Journal of the American College of Cardiology showed that 86.5% of the participants who underwent Roux-en-Y gastric bypass surgery reduced their total antihypertensive medication burden by at least 30% at 5 years, compared with just 12.5% of participants who received antihypertensive medical therapy alone. Additionally, the chance for hypertension remission 5 years after gastric bypass was nearly 20-fold higher than for those who received medical therapy only.
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“The GATEWAY trial showed that bariatric surgery can be very effective for treatment of patients with obesity and hypertension in the long term,” Carlos Aurelio Schiavon, MD, PhD, FACS, of the Center of Obesity and Bariatric Surgery at Hospital BP in Sao Paulo, told Healio. “The most important clinical implication of this trial is that we must treat obesity to accomplish success when treating patients with cardiovascular diseases such as hypertension.”
Hypertension remission after surgery
Schiavon and colleagues analyzed data from 100 adults with obesity plus hypertension prescribed at least two BP-lowering medications, who had no prior CVD (76% women; mean age, 44 years; mean BMI, 36.9 kg/m2). Researchers randomly assigned participants to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone. The primary outcome was a reduction of at least 30% of total antihypertensive medications while maintaining a BP less than 140/90 mm Hg at 5 years.
Within the cohort, 74% of the Roux-en-Y group and 64% of the medical therapy group completed the 5-year follow-up. At 5 years, mean BMI was 36.4 kg/m2 for participants in the medical therapy group and 28.01 kg/m2 for participants in the bariatric surgery plus medical therapy group (P < .001).
Compared with medical therapy, gastric bypass surgery was associated with a higher rate of BP medication reduction (80.7% vs. 13.7%), for an RR of 5.91 (95% CI, 2.58-13.52; P < .001). The mean number of antihypertensive medications was 2.97 for participants in the medical therapy group (95% CI, 2.33-3.6) and 0.8 for participants in the surgery group (95% CI, 0.51-1.09; P < .001).
The rates of hypertension remission were 2.4% in the medical therapy group and 46.9% in the surgery group, for an RR of 19.66 (95% CI, 2.74-141.09; P < .001). For those in the bariatric surgery group, the rate of apparent resistant hypertension was lower after the procedure (0% vs. 15.2%).
“To move forward, we need randomized trials comparing bariatric surgery with new anti-obesity drugs to demonstrate reduction in CV risk and mortality,” Schiavon told Healio.
Durable weight-loss strategies reduce CV risk
In a related editorial, Michael E. Hall, MD, MSc, associate professor of medicine, radiology, and physiology and biophysics, associate division director of cardiovascular diseases and director of clinical and population sciences at the Mississippi Center for Clinical and Translational Research at University of Mississippi Medical Center in Jackson, and colleagues wrote durable weight-loss strategies are important for reducing CV risk in people with obesity.
“The GATEWAY trial provides important long-term randomized controlled trial data showing the beneficial 5-year impact of Roux-en-Y gastric bypass on weight loss and BP control,” Hall and colleagues wrote. “Further studies assessing the threshold (mean BMI vs. other measures of adiposity) for bariatric surgery in people with obesity, optimal timing of bariatric surgery in obese people with cardiometabolic diseases (eg, after certain duration of obesity), type of bariatric surgery (Roux-en-Y gastric bypass vs. sleeve gastrectomy), and comparative studies of obesity pharmacotherapies and bariatric surgery are needed to clarify the optimal treatment pathways for this common and growing disease.”
Reference:
For more information:
Carlos Aurelio Schiavon, MD, PhD, FACS, can be reached at carlos.schiavon@bp.org.br; X (Twitter): @caschiavon.
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