Details

Autor(en) / Beteiligte

• Schiavon, Carlos A
• Bhatt, Deepak L
• Ikeoka, Dimas
• Santucci, Eliana V
• Santos, Renato Nakagawa
• Damiani, Lucas P
• Oliveira, Juliana D
• Machado, Rachel Helena V
• Halpern, Helio
• Monteiro, Frederico L J
• Noujaim, Patricia M
• Cohen, Ricardo V
• de Souza, Marcio G
• Amodeo, Celso
• Bortolotto, Luiz A
• Berwanger, Otavio
• Cavalcanti, Alexandre B
• Drager, Luciano F

Titel

Three-Year Outcomes of Bariatric Surgery in Patients With Obesity and Hypertension : A Randomized Clinical Trial

Ist Teil von

• Annals of internal medicine, 2020-11, Vol.173 (9), p.685-693

Ort / Verlag

United States

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• Midterm effects of bariatric surgery on patients with obesity and hypertension remain uncertain. To determine the 3-year effects of Roux-en-Y gastric bypass (RYGB) on blood pressure (BP) compared with medical therapy (MT) alone. Randomized clinical trial. (ClinicalTrials.gov: NCT01784848). Investigator-initiated study at Heart Hospital (HCor), São Paulo, Brazil. Patients with hypertension receiving at least 2 medications at maximum doses or more than 2 medications at moderate doses and with a body mass index (BMI) between 30.0 and 39.9 kg/m were randomly assigned (1:1 ratio). RYGB plus MT or MT alone. The primary outcome was at least a 30% reduction in total number of antihypertensive medications while maintaining BP less than 140/90 mm Hg. Key secondary outcomes were number of antihypertensive medications, hypertension remission, and BP control according to current guidelines (<130/80 mm Hg). Among 100 patients (76% female; mean BMI, 36.9 kg/m [SD, 2.7]), 88% from the RYGB group and 80% from the MT group completed follow-up. At 3 years, the primary outcome occurred in 73% of patients from the RYGB group compared with 11% of patients from the MT group (relative risk, 6.52 [95% CI, 2.50 to 17.03]; 0.001). Of the randomly assigned participants, 35% and 31% from the RYGB group and 2% and 0% from the MT group achieved BP less than 140/90 mm Hg and less than 130/80 mm Hg without medications, respectively. Median (interquartile range) number of medications in the RYGB and MT groups at 3 years was 1 (0 to 2) and 3 (2.8 to 4), respectively ( 0.001). Total weight loss was 27.8% and -0.1% in the RYGB and MT groups, respectively. In the RYGB group, 13 patients developed hypovitaminosis B and 2 patients required reoperation. Single-center, nonblinded trial. RYGB is an effective strategy for midterm BP control and hypertension remission, with fewer medications required in patients with hypertension and obesity. Ethicon, represented in Brazil by Johnson & Johnson do Brasil.