This year’s AHA Scientific Sessions has already provided the medical community with a number of excellent studies. The “GATEWAY” trial addresses the role of bariatric surgery and its effect on hypertension.1 Patients with morbid obesity are well known to be at risk for a litany of cardiorespiratory complications such as hypertension, obstructive sleep apnea, atrial fibrillation, among others. For many, dietary and lifestyle changes are insufficient measures to lose weight. The past decade has seen the emergence of bariatric surgery as a valid therapeutic approach. In trained hands and with meticulous follow-up, the results can be life-changing.
There already exists published literature regarding the favorable effects on glycemic control and in some cases resolution of type II diabetes in patients followed after Roux-en-Y bypass.2
GATEWAY (Gastric Bypass to Treat Obese Patients With Steady Hypertension) was a randomized trial comparing the effects of surgery to standard medical therapy in patients with morbid obesity (defined as BMI 30-39.9 Kg/m2) with the purpose of achieving control of hypertension. The surgery technique employed is known as a Roux-en-Y gastric bypass; these patients also received medical treatment.
The primary endpoint was reduction of ≥30% of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure <140 mm/90 mm Hg, respectively, at 12 months. Although the study did not enroll patients with diabetes mellitus, and was limited to 100 patients, the results are intriguing. In fact, the surgical arm was six times more likely to require less antihypertensives with more than half achieving remission of hypertension using the above target value. Encouragingly, the surgical complication rate was low.
This is encouraging data which also leads to additional questions:
- Are such results also obtainable with other surgical methods (Laparoscopic adjustable gastric banding; Sleeve gastrectomy;
- Duodenal switch with biliopancreatic diversion etc)3?
- Are the antihypertensive effects durable?
Larger studies will further validate these findings.
- Schiavon CA et al. Effects of Bariatric Surgery in Obese Patients With Hypertension The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). http://circ.ahajournals.org/content/early/2017/11/10/CIRCULATIONAHA.117.032130
- Schauer PR Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003 Oct;238(4):467-8
- Colquitt JL1, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014 Aug 8;(8):CD00364
Christian Perzanowski is an electrophysiologist in Tampa, FL. His main interests are ablation techniques for atrial fibrillation and device therapy for congestive heart failure.