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Cited by 308Bariatric Surgery and OutcomesBlood Pressure and Hypertension StudiesMinimally Invasive Surgical Techniques

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

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Schiavon, Carlos Aurelio, Bersch-Ferreira, Angela Cristine, Santucci, Eliana Vieira, Oliveira, Juliana Dantas, Torreglosa, Camila Ragne, Bueno, Priscila Torres, Frayha, Julia Caldas, Santos, Renato Nakagawa +13 more·2018·Circulation
DOI 10.1161/circulationaha.117.032130PMC PMC5865494
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Abstract

Background: Recent research efforts on bariatric surgery have focused on metabolic and diabetes mellitus resolution. Randomized trials designed to assess the impact of bariatric surgery in patients with obesity and hypertension are needed. Methods: In this randomized, single-center, nonblinded trial, we included patients with hypertension (using ≥2 medications at maximum doses or >2 at moderate doses) and a body mass index between 30.0 and 39.9 kg/m 2 . Patients were randomized to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone. The primary end point was reduction of ≥30% of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure <140 mm Hg and 90 mm Hg, respectively, at 12 months. Results: We included 100 patients (76% female, mean age 43.8±9.2 years, mean body mass index 36.9±2.7 kg/m2), and 96% completed follow-up. Reduction of ≥30% of the total number of antihypertensive medications while maintaining controlled blood pressure occurred in 41 of 49 patients from the gastric bypass group (83.7%) compared with 6 of 47 patients (12.8%) from the control group with a rate ratio of 6.6 (95% confidence interval, 3.1–14.0; P <0.001). Remission of hypertension was present in 25 of 49 (51%) and 22 of 48 (45.8%) patients randomized to gastric bypass, considering office and 24-hour ambulatory blood pressure monitoring, respectively, whereas no patient submitted to medical therapy was free of antihypertensive drugs at 12 months. A post hoc analysis for the primary end point considering the SPRINT (Systolic Blood Pressure Intervention Trial) target reached consistent results, with a rate ratio of 3.8 (95% confidence interval, 1.4–10.6; P =0.005). Eleven patients (22.4%) from the gastric bypass group and none in the control group were able to achieve SPRINT levels without antihypertensives. Waist circumference, body mass index, fasting plasma glucose, glycohemoglobin, low-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and 10-year Framingham risk score were lower in the gastric bypass than in the control group. Conclusions: Bariatric surgery represents an effective strategy for blood pressure control in a broad population of patients with obesity and hypertension. Clinical Trial Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT01784848.

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  • Visceral adipose tissue reduction following bariatric surgery rapidly decreases blood pressure.

    “VAT reduction following bariatric surgery (for example, vertical sleeve gastrectomy or Roux-en-Y gastric bypass) rapidly decreases BP16,17.”

    From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [16]

  • Individuals who gain excess adiposity maintain sodium balance at higher blood pressures than when they were lean, indicating impaired renal-pressure natriuresis.

    “individuals who gain excess adiposity maintain sodium balance at higher BPs than when they were lean, indicating impaired renal-pressure natriuresis16,51.”

    From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [16]

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  1. [15]Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Hipertensão, Sociedade Brasileira de Nefrologia. Arg Bras Cardiol 2010 95 1 51 21085756

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Authors
Schiavon, C. A., Bersch-Ferreira, A. C., Santucci, E. V., Oliveira, J. D., Torreglosa, C. R., Bueno, P. T., Frayha, J. C., Santos, R. N., Damiani, L. P., Noujaim, P. M., Halpern, H., Monteiro, F. L. J., Cohen, R. V., Uchoa, C. H., de Souza, M. G., Amodeo, C., Bortolotto, L., Ikeoka, D., Drager, L. F., Cavalcanti, A. B., & Berwanger, O.
Affiliations
  • Research Institute (C.A.S., A.C.B.-F., E.V.S., J.D.O., C.R.T., P.T.B., J.C.F., R.N.F., L.P.D., A.B.C., O.B.)
  • Surgical Center (P.M.N., H.H., F.L.J.M.)
  • Hospital Alemão Oswaldo Cruz (BR)
  • Heart Institute, Hypertension Unit, São Paulo, Brazil (C.H.U., L.B., L.F.D.).
  • Department of Hypertension, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil (M.G.d.S., C.A.).
  • Instituto Dante Pazzanese de Cardiologia (BR)
  • Instituto do Coração - HCFMUSP (BR)
  • Intensive Unit (D.I.), Heart Hospital, São Paulo, Brazil.
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-03-13
Volume
137
Issue
11
Pages
1132-1142
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.117.032130
PMC
PMC5865494
OpenAlex
W2770989673
Cited by
308
References
33
Citations by year
2026: 27 · 2025: 37 · 2024: 23 · 2023: 42 · 2022: 25 · 2021: 47 · 2020: 54 · 2019: 29 · 2018: 19 · 2017: 5
FWCI
29.99
Type
journal article
Language
en
Update notices
correction (2019-09-30)
Open access
Licence
cc-by
Locations
  • Circulation (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
Keywords
bariatric surgery, Roux-en-Y gastric bypass, obesity, hypertension, antihypertensive medication reduction, hypertension remission, blood pressure control, metabolic surgery, cardiovascular risk factors, body mass index, waist circumference, dyslipidemia, C-reactive protein, Framingham risk score, ambulatory blood pressure monitoring, type 2 diabetes remission
MeSH terms
Adult, Antihypertensive Agents, Blood Pressure, Brazil, Female, Humans, Hypertension, Male, Middle Aged, Obesity, Time Factors, Gastric Bypass, Weight Loss, Body Mass Index, Treatment Outcome

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