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Multicentre cohort study of antihypertensive and lipid-lowering therapy cessation after bariatric surgery

J Thereaux^1,2, T Lesuffleur¹, S Czernichow³

¹Department of Statistics, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France.

The British Journal of Surgery

|October 17, 2018

Insights

Bariatric surgery significantly reduces the need for antihypertensive and lipid-lowering medications. Gastric bypass surgery showed greater effectiveness in discontinuing these therapies compared to sleeve gastrectomy.

Area of Science:

Metabolic Surgery
Cardiovascular Pharmacology
Obesity Medicine

Background:

Limited research exists on medication changes post-bariatric surgery.
Antihypertensive and lipid-lowering therapies are commonly used in obese patients.

Purpose of the Study:

To evaluate 6-year changes in antihypertensive and lipid-lowering therapy use after bariatric surgery.
To compare these changes with a matched cohort of obese individuals not undergoing surgery.

Main Methods:

Nationwide, population-based, observational cohort study using French health insurance data.
Matched 8199 bariatric surgery patients (gastric bypass/sleeve gastrectomy) with controls.
Mixed-effect logistic regression analyzed treatment initiation/discontinuation over 6 years.

Main Results:

Bariatric surgery patients showed greater reductions in antihypertensive (-40.7% vs -11.7%) and lipid-lowering (-53.6% vs -20.2%) therapy compared to controls (P < 0.001).
Gastric bypass was a strong predictor for therapy discontinuation (OR 9.07 for antihypertensives, OR 11.91 for lipid-lowering).
Initiation of new therapies was lower post-bariatric surgery (5.6% vs 15.8% for hypertension, 2.2% vs 9.1% for hyperlipidemia).

Conclusions:

Bariatric surgery leads to significant discontinuation of antihypertensive and lipid-lowering therapies.
Gastric bypass is more effective than sleeve gastrectomy in reducing medication needs.

Read full analysis

Abstract

Background:

Few studies have assessed changes in antihypertensive and lipid-lowering therapy after bariatric surgery. The aim of this study was to assess the 6-year rates of continuation, discontinuation or initiation of antihypertensive and lipid-lowering therapy after bariatric surgery compared with those in a matched control group of obese patients.

Methods:

This nationwide observational population-based cohort study used data extracted from the French national health insurance database. All patients undergoing gastric bypass or sleeve gastrectomy in France in 2009 were matched with control patients. Mixed-effect logistic regression models were used to analyse factors that influenced discontinuation or initiation of treatment over a 6-year interval.

Results:

In 2009, 8199 patients underwent primary gastric bypass (55·2 per cent) or sleeve gastrectomy (44·8 per cent). After 6 years, the proportion of patients receiving antihypertensive and lipid-lowering therapy had decreased more in the bariatric group than in the control group (antihypertensives: -40·7 versus -11·7 per cent respectively; lipid-lowering therapy: -53·6 versus -20·2 per cent; both P < 0·001). Gastric bypass was the main predictive factor for discontinuation of therapy for hypertension (odds ratio (OR) 9·07, 95 per cent c.i. 7·72 to 10·65) and hyperlipidaemia (OR 11·91, 9·65 to 14·71). The proportion of patients not receiving treatment at baseline who were subsequently started on medication was lower after bariatric surgery than in controls for hypertension (5·6 versus 15·8 per cent respectively; P < 0·001) and hyperlipidaemia (2·2 versus 9·1 per cent; P < 0·001). Gastric bypass was the main protective factor for antihypertensives (OR 0·22, 0·18 to 0·26) and lipid-lowering medication (OR 0·12, 0·09 to 0·15).

Conclusion:

Bariatric surgery is associated with a good discontinuation of antihypertensive and lipid-lowering therapy, with gastric bypass being more effective than sleeve gastrectomy.

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