GATEWAY: Is Bariatric Surgery Effective For BP Control in Obese Patients?

Bariatric surgery may be an effective strategy for blood pressure control in patients with obesity and hypertension, according to results of the GATEWAY trial presented Nov. 13 at AHA 2017 in Anaheim, CA, and simultaneously published in Circulation.

Carlos Aurelio Schiavon, MD, PhD, et al., looked at 100 patients with hypertension and a body mass index between 30.0 and 39.0 kg/m2. Patients were randomized to Roux-en-Y gastric bypass plus medical therapy, or medical therapy alone.

The primary endpoint – a reduction of ≥30 percent of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure <140 mmHg and 90 mmHg, respectively, at 12 months – occurred in 41 of 49 patients (83.7 percent) in the gastric bypass group vs. six of 47 patients (12.8 percent) in the medical therapy alone group.

In a post-hoc analysis, 11 patients from the gastric bypass group and none in the medical therapy alone group were able to achieve SPRINT levels without antihypertensives.

The authors caution that given the morbidity of surgery, not all patients with obesity and hypertension with similar characteristics to those included in their trial should receive bariatric surgery.

However, they conclude that "gastric bypass represents one extra option to help achieve blood pressure control with the added benefit of improving metabolic and inflammatory profile." They add that "taken together, such effects have the potential to reduce major cardiovascular events," but moving forward, additional trials are needed to confirm these benefits.


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