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Shorter History of Hypertension as a Predictor of Hypertension Remission after 3-years of Bariatric Surgery: Data from the GATEWAY Trial

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Abstract

Background

Previous evidence explored predictors of hypertension (HTN) remission after bariatric but data are limited to observational studies and lack of ambulatory blood pressure monitoring (ABPM). This study was aimed to evaluate the rate of HTN remission after bariatric surgery using ABPM and to define predictors of mid-term HTN remission.

Methods

We included patients enrolled in the surgical arm of the GATEWAY randomized trial. HTN remission was defined as controlled blood pressure (< 130 × 80 mmHg) evaluated by 24-h ABPM while no need of anti-hypertensive medications after 36 months. A multivariable logistic regression model was used to assess the predictors of HTN remission after 36 months.

Results

46 patients submitted Roux-en-Y gastric bypass (RYGB). HTN remission occurred in 39% (n = 14 out of 36 patients with complete data at 36 months). Patients with HTN remission had shorter HTN history than no remission group (5.9 ± 5.5 vs. 12.5 ± 8.1 years; p = 0.01). The baseline insulin levels were lower in patients who presented HTN remission, although not statistically significant (OR: 0.90; CI 95%: 0.80–0.99; p = 0.07). In the multivariate analysis, the HTN history (years) was the only independent predictor of HTN remission (OR: 0.85; 95% CI: 0.70–0.97; p = 0.04). Therefore, for each additional year of HTN history, the chance of HTN remission decreases by approximately 15% after RYGB.

Conclusion

After 3 years of RYGB, HTN remission defined by ABPM was common and independently associated with a shorter HTN history. These data underscore the need of early effective approach of obesity aiming greater impact in its comorbidities.

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Data Availability

According to the TOP guidelines, the data supporting this study’s findings are available from the corresponding author upon reasonable request.

Abbreviations

HTN:

Hypertension

BP:

Blood pressure

RYGB:

Roux-en-Y gastric bypass

ABPM:

Ambulatory blood pressure monitoring

BMI:

Body mass index

WC:

Waist circumference

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Acknowledgements

We thank the Surgical Center and Ward staff, the Surgical Team, and the Research Institute from Heart Hospital for assistance with the GATEWAY trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension)..

Funding

This is an investigator-initiated study supported by Ethicon™ (Grant No. 100238). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Author information

Authors and Affiliations

  1. Unidade de Hipertensão, Disciplina de Nefrologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Avenida Dr Eneas de Carvalho Aguiar, 255, São Paulo, CEP 05403-900, Brazil

    Juliana D. Oliveira & Luciano F. Drager

  2. Research Institute - Heart Hospital (HCor) - São Paulo, São Paulo, Brazil

    Juliana D. Oliveira, Carlos A. Schiavon, Julia S. Oliveira, Renato N. Santos, Dimas Ikeoka, Eliana V. Santucci, Rachel Helena V. Machado & Alexandre B. Cavalcanti

  3. Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil

    Carlos A. Schiavon

  4. Albert Einstein Hospital - São Paulo, São Paulo, Brazil

    Lucas P. Damiani & Otavio Berwanger

  5. Unidade de Hipertensão, Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Luiz A. Bortolotto & Luciano F. Drager

  6. Cardiology Center, Hospital Sírio Libanês, São Paulo, Brazil

    Luciano F. Drager

Authors
  1. Juliana D. Oliveira
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  2. Carlos A. Schiavon
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  3. Julia S. Oliveira
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  11. Alexandre B. Cavalcanti
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  12. Luciano F. Drager
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Corresponding author

Correspondence to Luciano F. Drager.

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Key points

• Hypertension (HTN) remission is relatively common after bariatric surgery but the available evidence is limited to observational data and lack of ambulatory blood pressure monitoring (ABPM).

• After 3 years of Roux-en-Y gastric bypass (RYGB), data from the randomized study GATEWAY revealed that HTN remission defined by ABPM was common (39%) and independently associated with a shorter HTN history (each additional year of HTN history, the chance of HTN remission decreases by approximately 15% after RYGB).

• These data underscore the need of early effective approach of obesity aiming greater impact in its comorbidities.

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Oliveira, J.D., Schiavon, C.A., Oliveira, J.S. et al. Shorter History of Hypertension as a Predictor of Hypertension Remission after 3-years of Bariatric Surgery: Data from the GATEWAY Trial. OBES SURG 33, 2485–2492 (2023). https://doi.org/10.1007/s11695-023-06711-2

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