Bariatric Surgery Can Reduce Number Of Medications Needed To Control Blood Pressure Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Dr.
Carlos Aurelio Schiavon
Research Institute, Heart Hospital
São Paulo, Brazil What is the background for this study? What are the main findings?

Response: Obesity and hypertension are highly prevalent diseases and when they are associated,  cardiovascular risk is almost double over patients with obesity alone. 60-70% of hypertension in adults may be attributable to adiposity.

To address both problems, we designed the GATEWAY TRIAL to evaluate the efficacy of Gastric Bypass in the reduction of antihypertensive medications in obese patients using at least 2 medications at maximum doses.

After 1 year, results were very consistent. 83.7 % of the patients submitted to Gastric Bypass reduced at least 30% of the total number of medications maintaining a controlled blood pressure (<140/90 mm Hg) and 51% remitted from hypertension, defined by controlled blood pressure without medications. When we evaluated the reduction of the medication maintaining the Systolic blood pressure below 120 mmHg (SPRINT TARGET), 22.4% of the patients showed remission of hypertension. What should clinicians and patients take away from your report?

Response: Bariatric surgery is effective in the treatment of obese patients with hypertension, mainly those using more than two medications who show less adherence to treatment. Cardiologist and clinicians in general should think about referring this patients for an evaluation, mainly those with obesity grade 2 or over, using multiple drugs for hypertension and other comorbidities. What recommendations do you have for future research as a result of this study?

Response: We will follow this patient for 5 years and see if the results are durable. Besides that we should study more resistant patients and see if surgery can help in these difficult patients. A research over mechanisms of how bariatric surgery improves blood pressure besides weight loss is also a very interesting field. Is there anything else you would like to add?

Response: Bariatric surgery is a very safe procedure, with a mortality rate below 0.3%, similar to a Lap Cholecistectomy. We had no mortality in this group. Nutritional deficiencies can happen and patients should be strictetely followed-up to prevent and/or treat these problems. Thank you for your contribution to the community.


Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension)

Carlos Aurelio Schiavon, Angela Cristine Bersch-Ferreira, Eliana Vieira Santucci, Juliana Dantas Oliveira, Camila Ragne Torreglosa, Priscila Torres Bueno, Julia Caldas Frayha, Renato Nakagawa Santos, Lucas Petri Damian, Patricia Malvina Noujaim, Helio Halpern, Frederico L.J. Monteiro, Ricardo Vitor Cohen, Carlos H. Uchoa, Marcio Gonçalves de Souza, Celso Amodeo, Luiz Bortolotto, Dimas Ikeoka, Luciano F. Drager, Alexandre Biasi Cavalcanti, Otavio Berwanger

Circulation. 2017;CIRCULATIONAHA.117.032130
Originally published November 13, 2017

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Last Updated on November 16, 2017 by Marie Benz MD FAAD