Obesity Care

Gastric Bypass Surgery’s Durable Hypertension Impact

The associations between obesity and hypertension are widely known, but a new JACC study reveals that weight-reducing gastric bypass surgery has a significant and lasting impact on patients’ need for antihypertensives.

The GATEWAY trial assigned 100 participants (76% women, 43.8 avg. age, 36.9 BMI) to receive Roux-en-Y gastric bypass and medical therapy or only receive medical therapy, finding that after five years…

  • Far more gastric bypass patients cut their BP medication use by at least 30% (80.7% vs. 13.7%)
  • Gastric bypass patients were taking far fewer different BP medications (0.8 vs. 2.97 meds)
  • Nearly 20-times more bypass patients stopped taking any antihypertensive medication (46.9% vs. 2.4%)
  • All gastric bypass patients eliminated their resistant hypertension (from 15.2% to 0%)

Despite these massive BP medication reductions, the gastric bypass group saw no significant difference in blood pressure, and 54.7% of them achieved BPs below 130/80 mm Hg (vs. 9% in the medical therapy group).

Although previous research into gastric bypass surgery’s impact on cardiometabolic comorbidities often focused on diabetes, the GATEWAY trial makes an excellent case for gastric bypass’ ability to control hypertension – even five years after the procedure. 

The Takeaway

The fact that the GATEWAY trial came out at the same time as another paper showing that people who took tirzepatide (Eli Lilly’s Zepbound weight loss drug) also saw major BP reductions further highlights how weight interventions like these can lead to major hypertension improvements.

Considering that 122 million Americans have high blood pressure, and hypertension drives a long list of negative outcomes and high-cost care, research like this could start to change the way payers and providers might perceive  these “costly” interventions.

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