Skip to main content
SpringerLink
Log in

Bariatric Surgery for Resistant Hypertension: Working in Progress!

  • Resistant Hypertension (L Drager, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To discuss the recent evidence pointing the benefits of the bariatric surgery on blood pressure control in patients with obesity and hypertension. Particular focus is devoted to discuss the potential impact on resistant hypertension.

Recent Findings

Growing evidence suggest that bariatric surgery promotes not only a significant reduction in the anti-hypertensive medication while maintained blood pressure control but also a significant proportion of hypertension remission as compared to the usual care. In a sub-analysis of the GATEWAY trial using both office and 24–h ambulatory blood pressure monitoring, the prevalence of resistant hypertension significantly decreased after 12 months in the surgical group whereas the numbers remained stable in the control group.

Summary

Despite the lack of robust evidence, preliminary findings underscore the strong need to explore the potential role of bariatric surgery on resistant hypertension in patients with obesity. This statement is justified not only for the burden of obesity in this scenario but also for the unmet demands in managing resistant hypertension appropriately by multiple drug-therapy or the lack of real utility of procedures like renal denervation and carotid baroreflex activation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:2199–269 The last American Hypertension Guidelines that introduced new criteria and targets for hypertension.

    Article  PubMed  Google Scholar 

  2. • Krieger EM, Drager LF, DMA G, Pereira AC, JAS B-F, Nogueira AR, et al. Spironolactone versus clonidine as a fourth-drug therapy for resistant hypertension: the ReHOT randomized study (Resistant Hypertension Optimal Treatment). Hypertension. 2018;71(4):681–90 The REHOT trial is one of the few randomized trials to specifically tested the best forth therapy in the resistant hypertension scenario.

    Article  CAS  PubMed  Google Scholar 

  3. Achelrod D, Wenzel U, Frey S. Systematic review and meta-analysis of the prevalence of resistant hypertension in treated hypertensive populations. Am J Hypertens. 2015;28:355–61.

    Article  PubMed  Google Scholar 

  4. Sarafidis PA, Georgianos P, Bakris GL. Resistant hypertension—its identification and epidemiology. Nat Rev Nephrol. 2013;9:51–8.

    Article  PubMed  Google Scholar 

  5. Gijón-Conde T, Graciani A, Banegas JR. Resistant hypertension: demography and clinical characteristics in 6292 patients in a primary health care setting. Rev Esp Cardiol. 2014;67:270–6.

    Article  PubMed  Google Scholar 

  6. Tsioufis C, Kasiakogias A, Kordalis A, Dimitriadis K, Thomopoulos C, Tsiachris D, et al. Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity: a 4-year prospective study. J Hypertens. 2014;32:415–22.

    Article  CAS  PubMed  Google Scholar 

  7. Pierdomenico SD, Lapenna D, Bucci A, Di Tommaso R, Di Mascio R, Manente BM, et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens. 2005;18:1422–8.

    Article  PubMed  Google Scholar 

  8. Sim JJ, Bhandari SK, Shi J, Reynolds K, Calhoun DA, Kalantar-Zadeh K, et al. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney Int. 2015;88:622–32.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Viazzi F, Piscitelli P, Giorda C, Ceriello A, Genovese S, Russo GT, et al. Association of kidney disease measures with risk of renal function worsening in patients with hypertension and type 2 diabetes. J Diabetes Complicat. 2017;31:419–26.

    Article  Google Scholar 

  10. Pedrosa RP, Drager LF, de Paula LKG, Amaro ACS, Bortolotto LA, Lorenzi-Filho G. Effects of OSA treatment on BP in patients with resistant hypertension. A randomized trial. Chest. 2013;14:1487–94.

    Article  Google Scholar 

  11. Oliveras A, de la Sierra A. Resistant hypertension: patient characteristics, risk factors, co-morbidities and outcomes. J Hum Hypertens. 2014;28:213–7.

    Article  CAS  PubMed  Google Scholar 

  12. Cuspidi C, Macca G, Sampieri L, Michev I, Salerno M, Fusi V, et al. High prevalence of cardiac and extracardiac target organ damage in refractory hypertension. J Hypertens. 2001;19:2063–70.

    Article  CAS  PubMed  Google Scholar 

  13. Holecki M, Duława J, Chudek J. Resistant hypertension in visceral obesity. Eur J Intern Med. 2012;23:643–8.

    Article  PubMed  Google Scholar 

  14. De Marco VG, Aroor AR, Sowers JR. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014;10:364–76.

    Article  Google Scholar 

  15. Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation. 2011;124:1046–58.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6–10.

    Article  CAS  PubMed  Google Scholar 

  17. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32(9):1431–7.

    Article  CAS  Google Scholar 

  18. Reisin E, Owen J. Treatment—special conditions: metabolic syndrome: obesity and the hypertension connection. J Am Soc Hypertens. 2015;9(2):156–9.

    Article  PubMed  Google Scholar 

  19. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003;42(5):878–84.

    Article  CAS  PubMed  Google Scholar 

  20. Zhang R, Reisin E. Obesity-hypertension: the effects on cardiovascular and renal systems. Am J Hypertens. 2000;13:1308–14.

    Article  CAS  PubMed  Google Scholar 

  21. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37. https://doi.org/10.1001/jama.292.14.1724.

    Article  CAS  PubMed  Google Scholar 

  22. Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98:1763–77. https://doi.org/10.1136/heartjnl-2012-301778.

    Article  PubMed  Google Scholar 

  23. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  24. Näslund I, Carlsson LM, Fändriks L. Gastric bypass surgery is followed by lowered blood pressure and increased diuresis - long term results from the Swedish obese subjects (SOS) study. PLoS One. 2012;7:e49696. https://doi.org/10.1371/journal.pone.0049696.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. • Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377:1143–55. https://doi.org/10.1056/NEJMoa1700459This is the longest follow-up observational study to date that evaluates the benefits of hypertension, diabetes and dyslipidemia remission and incidence after bariatric surgery.

    Article  PubMed  PubMed Central  Google Scholar 

  26. • Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes — 5-year outcomes. N Engl J Med. 2017;376(7):641–51 One of the most famous trials in the bariatric surgery field primarily to explore the impact of bariatric surgery on type 2 diabetes.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.

    Article  PubMed  Google Scholar 

  28. Ikramuddin S, Korner J, Lee W-J, Thomas AJ, Connett JE, Bantle JP, et al. Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A 1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. JAMA. 2018;319(3):266–13.

    Article  PubMed  PubMed Central  Google Scholar 

  29. •• Schiavon CA, Bersch-Ferreira AC, Santucci EV, et al. Effects of bariatric surgery in obese patients with hypertension: the GATEWAY randomized trial (gastric bypass to treat obese patients with steady hypertension). Circulation. 2018;137(11):1132–42. Erratum in: Circulation. 2019;140(14):e718. The first randomized trial devoted to hypertension in bariatric surgery.

  30. Schiavon CA, Bhatt DL, Santucci EV, Oliveira JD, Santos RN, Damiani LP, et al. Effects of bariatric surgery in patients with Hypertension: 3-year outcomes from the randomized GATEWAY trial. Circulation. 2019;140:e972. https://doi.org/10.1161/CIR.0000000000000742.

    Article  Google Scholar 

  31. •• Schiavon CA, Ikeoka D, Santucci EV, et al. Effects of bariatric surgery versus medical therapy on the 24-hour ambulatory blood pressure and the prevalence of resistant hypertension: The GATEWAY randomised clinical trial. Hypertension. 2019;73(3):571–7 The first trial that performed an exploratory analysis on the impact of bariatric surgery on resistant hypertension using 24h ambulatory blood pressure monitoring.

    Article  CAS  PubMed  Google Scholar 

  32. • Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72(5):e53–90 The last American Guidelines on Resistant Hypertension.

    Article  CAS  PubMed  Google Scholar 

  33. Pio-Abreu A, Drager LF. Resistant hypertension: time to consider the best fifth anti-hypertensive treatment. Curr Hypertens Rep. 2018 Jun 16;20(8):67.

    Article  PubMed  Google Scholar 

  34. Bhatt DL, Kandzari DE, O'Neill WW, D'Agostino R, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–401.

    Article  CAS  PubMed  Google Scholar 

  35. de Leeuw PW, Bisognano JD, Bakris GL, Nadim MK, Haller H, Kroon AA, et al. Sustained reduction of blood pressure with baroreceptor activation therapy: results of the 6-year open follow-up. Hypertension. 2017;69(5):836–43.

    Article  PubMed  Google Scholar 

  36. Lobo MD, Sobotka PA, Stanton A, Cockcroft JR, Sulke N, Dolan E, et al. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial. Lancet. 2015;385(9978):1634–41. https://doi.org/10.1016/S0140-6736(14)62053-5. Erratum in: Lancet. 2016 Feb 13;387(10019):648. Erratum in: Lancet. 2015 Apr 25;385(9978):1622.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bariatric Surgery Center, BP Hospital, Sao Paulo, Brazil

    Carlos A. Schiavon

  2. Research Institute, Heart Hospital (HCor), Abilio Soares St, 250, 12th Floor, Sao Paulo, SP, 04004-050, Brazil

    Carlos A. Schiavon

  3. Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, Brazil

    Andrea Pio-Abreu & Luciano F. Drager

  4. Heart Institute (InCor), Hypertension Unit, University of São Paulo Medical School, São Paulo, Brazil

    Luciano F. Drager

Authors
  1. Carlos A. Schiavon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Pio-Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luciano F. Drager
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos A. Schiavon.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest. Dr. Carlos A. Schiavon received a Research Grant from Ethicon Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Resistant Hypertension

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schiavon, C.A., Pio-Abreu, A. & Drager, L.F. Bariatric Surgery for Resistant Hypertension: Working in Progress!. Curr Hypertens Rep 22, 55 (2020). https://doi.org/10.1007/s11906-020-01055-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-020-01055-z

Keywords

Search

Navigation