In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 18, No. 11 ( 2021-11-1), p. e1003817-
Abstract:
Several studies have shown that metabolic surgery is associated with remission of diabetes and hypertension. In terms of diabetes, factors such as duration, insulin use, weight loss, and age have been shown to contribute to the likelihood of remission. Such factors have not been determined for hypertension. The aim of this study was to evaluate factors associated with the remission and relapse of hypertension after metabolic surgery, as well as the risk for major adverse cardiovascular event (MACE) and mortality in patients with and without remission. Methods and findings All adults who underwent metabolic surgery between January 2007 and June 2016 were identified in the nationwide Scandinavian Obesity Surgery Registry (SOReg). Through cross-linkage with the Swedish Prescribed Drug Register, Patient Register, and Statistics Sweden, individual data on prescriptions, inpatient and outpatient diagnoses, and mortality were retrieved. Of the 15,984 patients with pharmacologically treated hypertension, 6,286 (39.3%) were in remission at 2 years. High weight loss and male sex were associated with higher chance of remission, while duration, number of antihypertensive drugs, age, body mass index (BMI), cardiovascular disease, and dyslipidemia were associated with lower chance. After adjustment for age, sex, BMI, comorbidities, and education, the cumulative probabilities of MACEs (2.8% versus 5.7%, adjusted odds ratio (OR) 0.60, 95% confidence interval (CI) 0.47 to 0.77, p 〈 0.001) and all-cause mortality (4.0% versus 8.0%, adjusted OR 0.71, 95% CI 0.57 to 0.88, p = 0.002) were lower for patients being in remission at 2 years compared with patients not in remission, despite relapse of hypertension in 2,089 patients (cumulative probability 56.3%) during 10-year follow-up. The main limitations of the study were missing information on nonpharmacological treatment for hypertension and the observational study design. Conclusions In this study, we observed an association between high postoperative weight loss and male sex with better chance of remission, while we observed a lower chance of remission depending on disease severity and presence of other metabolic comorbidities. Patients who achieved remission had a halved risk of MACE and death compared with those who did not. The results suggest that in patients with severe obesity and hypertension, metabolic surgery should not be delayed.
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003817
DOI:
10.1371/journal.pmed.1003817.g001
DOI:
10.1371/journal.pmed.1003817.g002
DOI:
10.1371/journal.pmed.1003817.g003
DOI:
10.1371/journal.pmed.1003817.g004
DOI:
10.1371/journal.pmed.1003817.t001
DOI:
10.1371/journal.pmed.1003817.t002
DOI:
10.1371/journal.pmed.1003817.t003
DOI:
10.1371/journal.pmed.1003817.s001
DOI:
10.1371/journal.pmed.1003817.s002
DOI:
10.1371/journal.pmed.1003817.s003
DOI:
10.1371/journal.pmed.1003817.s004
DOI:
10.1371/journal.pmed.1003817.s005
DOI:
10.1371/journal.pmed.1003817.s006
DOI:
10.1371/journal.pmed.1003817.s007
DOI:
10.1371/journal.pmed.1003817.s008
DOI:
10.1371/journal.pmed.1003817.s009
DOI:
10.1371/journal.pmed.1003817.r001
DOI:
10.1371/journal.pmed.1003817.r002
DOI:
10.1371/journal.pmed.1003817.r003
DOI:
10.1371/journal.pmed.1003817.r004
DOI:
10.1371/journal.pmed.1003817.r005
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2021
detail.hit.zdb_id:
2164823-2
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