The Effect of Bariatric Surgery on Hypertension Outcomes: A Retrospective Cohort Study

Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and metabolic syndrome. Evidence regarding the impact of MBS on hypertension outcomes is limited by short-term follow-up. Thus, this retrospective cohort study was designed to compare blood pressure (BP) control, number of antihypertensive medications (AHMs), development of apparent treatment resistant hypertension (ATRH), and remission of hypertension between patients treated with and without MBS. Adults with BMI ≥ 35 kg/m² and a new diagnosis of hypertension receiving care within the Veterans Health Administration system from 2000-2019 were included. Generalized estimating equations and time-updated Cox models with inverse probability of treatment weighting to address time-updated confounding were used. Over a median follow-up of 5.1 years, 183702 patients with BMI ≥ 35 kg/m² and hypertension were managed medically and 3965 were managed surgically. At baseline, those who underwent MBS were more likely to be women than men (22 vs. 10%). Patients treated surgically demonstrated significantly better BP control over time, with an average 5.4 mm Hg (95% CI 4.9-5.9) lower systolic BP and 1.8 mm Hg (95% CI 1.5-2.1) lower diastolic BP. Compared to patients treated medically, those who received MBS had 32% higher likelihood of complete AHM discontinuation (95% CI 1.23-1.42). Patients treated with MBS were 14% less likely to develop ATRH (95% CI 0.78-0.95). Overall, among patients with obesity and hypertension, treatment with MBS was associated with durably improved BP control compared to medical management, including lower systolic and diastolic BPs, higher AHM cessation, and lower rates of ATRH.