Bariatric Surgery and Hypertension
Obesity and arterial hypertension are connected, and it becomes more evident in patients with severe obesity. Bariatric surgery over the past years has become the most effective treatment option for severe obesity; however, the benefits of surgery extend beyond weight loss.
Bariatric surgery can improve various obesity-related complications; one such condition is hypertension. Here is an overview of how bariatric surgery can improve arterial hypertension in short- and long-term follow-ups.
Hypertension is one of the most common cardiovascular risk factors, and there is a close relationship between obesity and hypertension. Around 60 to 77% of people with obesity have the complication of hypertension, and it is high compared to normal-weight people. Obesity increases the risk of developing hypertension through a variety of changes to the cardiovascular system.
Conventional medical treatment (non-surgical) has favourable results for severe obesity, but they may not last long because of poor long-term maintenance of lifestyle in some patients. However, experts proved that bariatric surgery is the most effective treatment option for these patients, as it provides exceptional weight loss along with certain comorbidity remissions following surgery, including hypertension.
Understanding hypertension and its risks
Hypertension means high blood pressure, where the pressure in your blood vessels becomes too high (140/90 mmHg or higher). It is common, but if not treated in time, it may result in cardiovascular diseases like heart attack, stroke, and heart failure. Along with heart problems, this condition may also result in other serious health complications, like kidney damage, vision loss, etc.
Many factors contribute to the development of hypertension, which include genetics (familial history), lifestyle choices, and various other underlying health problems. Obese people are at higher risk of developing hypertension because excess body weight puts a heavy workload on the heart, which increases pressure in your blood vessels.
Obesity and hypertension are correlated. Excess body fat, especially visceral fat accumulated around the abdomen, can increase insulin resistance, which increases blood sugar levels and results in hypertension.
Hormones like leptin regulate blood pressure; excess production of these hormones can elevate blood pressure.
The physical changes that happen as a result of obesity increase blood volume and stiffness in arterial walls, and they increase the workload on the heart.
Bariatric surgery: An effective solution for weight loss and related complications
Bariatric surgery, a special surgical procedure designed to help people struggling to lose their excess weight. This surgery mainly involves modifying the digestive system so that less food is consumed.
A review that was published in 2004 by Buchwald et al. states that three out of every five patients who have had bariatric surgery have achieved hypertension remission. The study was conducted on 22,094 patients who underwent different bariatric procedures like gastric bypass (GB), gastric band, and biliopancreatic diversion. They analysed short-term follow-ups with the surgical procedures, and most studies are regarding hypertension remission.
In recent years, laparoscopic sleeve gastrectomy has become the most emerging bariatric surgery technique globally, as the procedure offers excellent mid- and long-term results following surgery. Furthermore, the potential underlying mechanisms that improve hypertension following bariatric surgery have been studied, along with other advantages beyond weight loss.
Short-term effects on hypertension
A few trials have been conducted to analyse remission of hypertension in the short term (less than 3 years) following bariatric surgery. Schiavon and others published the first theory in 2018 aimed at evaluating bariatric surgery’s effects on hypertension remission.
The trial focused on obese patients with hypertension who have had gastric bypass and medical therapy alone. The remission of hypertension occurred more frequently in the gastric bypass group (83.7%) compared to the medical therapy group (12.8%). Furthermore, approximately 50% of the patients in the gastric bypass group and none in the medical therapy group experienced hypertension remission after a year following surgery, stopping all medication.
Hence, considering all the results, if bariatric surgery was primarily recommended for hypertension, the chance of remission would be around 50% in the short term.
Mid- and long-term effects on hypertension
Studies on the mid- (3–5 years) and long-term (>5 years) effects of bariatric surgery on hypertension remission are limited compared to other obesity complications like type 2 diabetes. The mid- and long-term outcomes after bariatric surgery were less remarkable compared to those obtained during a short-term follow-up.
A 36-month follow-up regarding hypertension remission after bariatric surgery revealed that 68.1% of patients were free from hypertension after 1 year. However, 21.9% of patients regained the condition after 3 years. This unfavourable result was explained as it happened because of regaining weight.
Other studies
A study that was published in JAMA Surgery (an international peer-reviewed journal) revealed that approximately 50% of obese patients who have had bariatric surgery experienced hypertension remission after one year.
The Swedish Obese Subjects (SOS) study, the first long-term controlled study, demonstrated that hypertension remission was significantly higher in bariatric surgery patients than in a control group.
Another review was published in The American Journal of Hypertension, and it says that in their study, they observed improvement of hypertension in 72% of patients, and 42% of them achieved complete remission within 2 years following surgery.
If you are suffering from obesity and related complications, don’t hesitate to consult a weight loss specialist for a precise diagnosis and treatment. Call +91 91777-77715 to book your appointment with Dr. Venugopal Pareek, one of the best bariatric surgeons in Hyderabad and an expert in managing obesity-related complications.
