# Bariatrische chirurgie en bloeddruk na 5 jaar: gerandomiseerde trial

*geplaatst 2024-02-13 · Preventie · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2023.11.032 · https://hartvaat.nl/2024/02/13/bariatrische-chirurgie-en-bloeddruk-na-5-jaar-gerandomiseerde-trial/*

Gerandomiseerde trial toonde dat bariatrische chirurgie de bloeddruk na 5 jaar significant beter verlaagde dan leefstijlinterventie bij patiënten met obesitas en hypertensie. Het voordeel was duurzaam en geassocieerd met minder antihypertensivagebruik.

## English: Randomized Trial of Effect of Bariatric Surgery on Blood Pressure After 5 Years.

This 5-year randomized trial confirmed that bariatric surgery provides superior long-term blood pressure reduction compared with lifestyle intervention alone in obese hypertensive patients, supporting surgical weight loss as an effective antihypertensive strategy.

## Abstract (original, from the publication)

BACKGROUND: Obesity represents a major obstacle for controlling hypertension, the leading risk factor for cardiovascular mortality. OBJECTIVES: The purpose of this study was to determine the long-term effects of bariatric surgery on hypertension control and remission. METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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).

Auteurs: Carlos A Schiavon, Alexandre B Cavalcanti, Juliana D Oliveira, Rachel H V Machado, Eliana V Santucci, Renato N Santos, Julia S Oliveira, Lucas P Damiani, Débora Junqueira, Helio Halpern, Frederico de L J Monteiro, Patricia M Noujaim, Ricardo V Cohen, Marcio G de Sousa, Luiz A Bortolotto, Otavio Berwanger, Luciano F Drager

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2023.11.032. Bijgewerkt 2026-07-03T13:29:50Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.