A meta-analysis found that bariatric surgery was more effective than medication and lifestyle changes for controlling hypertension in patients with obesity. 

In the study, presented at the American Heart Association's Hypertension Scientific Sessions 2024, investigators analyzed data from 18 randomized controlled clinical trials involving 1,386 patients with obesity and hypertension conducted between December 2002 and May 2024. The study population comprised 62.7% women and 37.3% men, with a mean body mass index of 38 kg/m². The analysis compared outcomes between patients who underwent various bariatric procedures and those who received standard medical therapy and lifestyle interventions.

Study details:

• The follow-up periods ranged from 1 to 5 years across the included trials.
• Most of the studies focused on Roux-en-Y gastric bypass and sleeve gastrectomy procedures.
• A subgroup analysis of five studies examined hypertension remission and medication use, with four of the studies having hypertension as the primary outcome.
• At baseline in these four studies, patients received maximum doses of at least two antihypertensive medications.

Among the key findings were:

• Patients who underwent bariatric surgery were 2.77 times more likely to achieve blood pressure remission (< 140/90 mmHg without medication) compared with controls.
• The surgery group was 7.1 times more likely to achieve blood pressure control (< 130/80 mmHg with reduced medication use) compared with the control group.
• On average, the surgery group experienced a 3.67 mmHg greater reduction in systolic blood pressure compared with the control group.

The investigators noted several limitations of the study, including heterogeneity among trials in baseline characteristics, surgical techniques, obesity diagnosis criteria, and follow-up duration. Additionally, many studies had small sample sizes, and only four of the 18 trials focused primarily on hypertension outcomes.

The findings indicated that bariatric surgery may be a durable solution for obesity-related hypertension, resulting in high blood pressure remission while reducing dependence on blood pressure medications.

The investigators stressed the need for randomized clinical studies comparing bariatric surgery with newer weight-loss medications to determine optimal treatment strategies for specific patient populations.

They recommended conducting larger, long-term randomized controlled trials with a specific focus on hypertension outcomes. The investigators also suggested evaluating the efficacy and cost-effectiveness of different bariatric procedures for various patient profiles.