Is surgery the next answer to treat obesity-related hypertension?

Obesity is related to multiple comorbidities, including hypertension, diabetes, hypercholesterolemia, and sleep apnea. Comorbidities burden the health care system, such that in the United States, 6% to 8% of health care costs are related to obesity. Obesity-induced hypertension has multiple potential etiologic pathways, the most well established being increased renal sodium reabsorption with impaired pressure natriuresis via (1) activation of the renin-angiotensin system, (2) stimulation of the sympathetic nervous system, and (3) altered intrarenal physical forces. Weight loss is the best means to reduce obesity-related hypertension. For every 3 patients who lose 10 pounds of weight and maintain the weight loss for 4 years, 1 of them will eliminate the use of antihypertensive medication. Whereas nonsurgical therapy ineffectually treats extreme obesity, bariatric surgery yields durable weight loss, as well as resolution of some of the comorbidities associated with obesity, including hypertension. Increase in anti-inflammatory factors secreted by adipocytes may explain some of the improvement in blood pressure in the first 3 years post-procedure. Bariatric surgery safely and effectively improves and may improve or eliminate obesity-related hypertension. More data need to be collected to substantiate the same results over periods of time longer than 3 years.