Weight-loss surgery may help people with obesity better manage high blood pressure

People with obesity who had weight-loss surgery were able to better manage their high blood pressure in the long term than those using medications and lifestyle changes, a new analysis finds.

The research, being presented Friday at the American Heart Association's Hypertension Scientific Sessions in Chicago, is considered preliminary until full results are published in a peer-reviewed journal. The results were based on an analysis of data from 18 randomized controlled trials involving more than 1,300 participants.

"Our findings indicate bariatric surgery is a durable solution for obesity-related hypertension since it results in high blood pressure remission, or long-term control, while reducing the dependence on blood pressure medications," lead researcher Dr. Sneha Annie Sebastian said in a news release. Sebastian is a researcher and a residency candidate from Alberta, Canada.

"Additionally, by improving blood pressure control, bariatric surgery also lowers the risk of cardiovascular disease and enhances overall heart health," she said.

Bariatric surgery reduces the size of a person's stomach, helping them feel full after eating less. It also can change the structure of the digestive system so that fewer nutrients and calories are absorbed. The American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders recommend the procedure for anyone with a body mass index of 35 or higher.

In the new analysis, researchers combined data for 1,386 adults with high blood pressure and obesity who took part in 18 studies across several countries from December 2002 to May 2024. Participants in the studies were randomly assigned to undergo bariatric surgery or a nonsurgical, medication or lifestyle intervention. Follow-ups were conducted for up to five years. Several types of weight-loss surgery were used in the studies, but most focused on Roux-en-Y gastric bypass and sleeve gastrectomy.

Compared to people assigned to the control group, those who underwent bariatric surgery were nearly three times more likely to lower their blood pressure to less than 140/90 mmHg without the need for blood pressure-lowering medication. They also were seven times more likely to lower it to less than 130/80 mmHg while substantially reducing their use of blood pressure-lowering medication. The bariatric surgery group lowered their systolic blood pressure – the top number – an average 3.67 mmHg more than those in the control group.

Sebastian said future research should focus on large randomized controlled trials with long-term follow-up, with a specific emphasis on hypertension since many currently focus on diabetes outcomes. "Furthermore, it is essential to evaluate the efficacy and cost-effectiveness of different bariatric procedures for various patient profiles and to identify optimal candidates for each type of surgery," she said.

The findings underscore the beneficial impact of weight loss on blood pressure control, Dr. Michael E. Hall said in the news release. Hall, who was not involved with the new research, was chair of the writing group for the AHA's 2021 scientific statement on weight-loss strategies for preventing and treating hypertension. He also is chair of the department of medicine at the University of Mississippi Medical Center in Jackson.

"Bariatric surgery consistently improved blood pressure control in individuals with obesity," he said about the findings. "Further, given the effectiveness of newer weight loss medications and beneficial effects on cardiometabolic conditions like hypertension, we need randomized clinical studies comparing bariatric surgery to these newer medications to decide which people are better suited for a specific weight-loss strategy."