医学
随机对照试验
体质指数
血压
肥胖
糖尿病
减肥
风险因素
外科
2型糖尿病
胃肠病学
内科学
内分泌学
作者
Carlos A. Schiavon,Alexandre Biasi Cavalcanti,Juliana Dantas de Oliveira,Rachel Helena Vieira Machado,Eliana Vieira Santucci,Renato Nakagawa Santos,Julia S. Oliveira,Lucas Petri Damiani,Débora Junqueira Campos Paranhos,Hélio Halpern,Frederico de Lima Jacy Monteiro,Patricia Malvina Noujaim,Ricardo Cohen,Márcio Gonçalves de Sousa,Luiz Aparecido Bortolotto,Otávio Berwanger,Luciano F. Drager
标识
DOI:10.1016/j.jacc.2023.11.032
摘要
Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. We conducted a randomized clinical trial with subjects with obesity grade 1 or 2 plus hypertension using at least 2 medications. We excluded subjects with previous cardiovascular events and poorly controlled type 2 diabetes. Subjects were assigned to Roux-en-Y gastric bypass (RYGB) combined with medical therapy (MT) or MT alone. We reassessed the original primary outcome (reduction of at least 30% of the total antihypertensive medications while maintaining blood pressure levels <140/90 mm Hg) at 5 years. The main analysis followed the intention-to-treat principle. A total of 100 subjects were included (76% women, age 43.8 ± 9.2 years, body mass index: 36.9 ± 2.7 kg/m2). At 5 years, body mass index was 36.40 kg/m2 (95% CI: 35.28-37.52 kg/m2) for MT and 28.01 kg/m2 (95% CI: 26.95-29.08 kg/m2) for RYGB (P < 0.001). Compared with MT, RYGB promoted a significantly higher rate of number of medications reduction (80.7% vs 13.7%; relative risk: 5.91; 95% CI: 2.58-13.52; P < 0.001) and the mean number of antihypertensive medications was 2.97 (95% CI: 2.33-3.60) for MT and 0.80 (95% CI: 0.51-1.09) for RYGB (P < 0.001). The rates of hypertension remission were 2.4% vs 46.9% (relative risk: 19.66; 95% CI: 2.74-141.09; P < 0.001). Sensitivity analysis considering only completed cases revealed consistent results. Interestingly, the rate of apparent resistant hypertension was lower after RYGB (0% vs 15.2%). Bariatric surgery represents an effective and durable strategy to control hypertension and related polypharmacy in subjects with obesity. (GAstric bypass to Treat obEse Patients With steAdy hYpertension [GATEWAY]; NCT01784848)
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