Tuesday, June 18, 2024

Metabolic and Bariatric Surgery Significantly Reduces Antihypertensive Medication Use

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In a groundbreaking study, researchers have revealed that metabolic and bariatric surgery (MBS) not only serves as a potent treatment for obesity but also plays a crucial role in managing hypertension. By examining the comparative paths of antihypertensive medication (AHM) use among obese individuals who underwent MBS versus those who did not, the study provides compelling evidence of the surgery’s effectiveness in reducing reliance on medication for blood pressure control.

Methods and Analysis

The study scrutinized data from the Merative database, focusing on adults with a body mass index (BMI) of 35 kg/m2 or higher. A total of 43,206 individuals who underwent MBS were meticulously matched with an equal number of individuals who did not undergo the surgery, based on demographic and clinical characteristics, including baseline AHM usage. Researchers employed generalized estimating equations to track monthly AHM use over a three-year period following the index date.

Further subanalyses delved into specific aspects such as rates of AHM discontinuation, initiation, and the incidence of apparent treatment-resistant hypertension. These detailed examinations aimed to provide a comprehensive understanding of the impact of MBS on hypertension management.

Findings

The results were striking. Individuals who underwent MBS exhibited consistently lower rates of AHM use compared to those who did not have the surgery—15% versus 31% at 12 months, and 17% versus 32% at 36 months. Among those who were already on AHM at the beginning of the study, 42% of MBS patients managed to discontinue its use, in stark contrast to just 7% among those treated medically (P<0.01).

Moreover, the risk of developing apparent treatment-resistant hypertension was found to be 3.41 times higher (95% CI, 2.91-4.01; P<0.01) two years post-index date in individuals who did not undergo MBS. For those without hypertension at baseline, only 7% of MBS patients required AHM two years later, compared to 21% of non-MBS patients.

Key Takeaways for Healthcare Providers

– MBS patients showed a significant reduction in AHM use over three years.
– There was a markedly higher rate of AHM discontinuation among MBS patients.
– Non-MBS patients had a substantially higher risk of developing treatment-resistant hypertension.
– MBS also proved effective in preventing the need for AHM in patients initially without hypertension.

In conclusion, metabolic and bariatric surgery not only effectively treats obesity but also serves as a powerful preventive measure against hypertension. These findings underscore the importance of considering MBS as a viable option for long-term hypertension management and prevention.

Original Article: Hypertension. 2024 Jun 4. doi: 10.1161/HYPERTENSIONAHA.124.23054. Online ahead of print.

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