Shimada Yuichi J, Tsugawa Yusuke, Iso Hiroyasu, Brown David F M, Hasegawa Kohei
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Gray/Bigelow 800, Boston, MA, 02114, USA.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
BMC Med. 2017 Aug 23;15(1):161. doi: 10.1186/s12916-017-0914-5.
Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension.
We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period.
We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P < 0.0001). Similarly, the risk remained significantly reduced in the 13-24 months after bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy).
In this population-based study of obese adults with hypertension, we found that the risk of acute care use for hypertension-related disease decreased by 40% after bariatric surgery. The data provide the best evidence on the effectiveness of substantial weight loss on hypertension-related morbidities, underscoring the importance of discussing options for weight reduction when treating obese patients with hypertension.
高血压给社会带来了沉重负担。肥胖是已知的高血压危险因素。然而，关于减肥干预措施是否能降低高血压相关不良事件的风险，如急性护理使用（急诊就诊和/或非计划住院），人们知之甚少。我们采用减肥手术作为一种手段，来研究大幅减重对肥胖高血压成年患者高血压相关疾病急性护理使用风险的影响。
我们利用基于人群的急诊和住院数据库，对接受减肥手术的肥胖高血压患者进行了一项自我对照病例系列研究。该数据库记录了2005年至2011年三个州（加利福尼亚州、佛罗里达州和内布拉斯加州）的每例减肥手术、急诊就诊和住院情况。主要结局是高血压相关疾病的急性护理使用。我们使用条件逻辑回归来比较每位患者在连续12个月期间发生结局事件的风险，以术前13 - 24个月作为参照期。
我们确定了980例接受减肥手术的肥胖高血压患者。中位年龄为48岁（四分位间距为40 - 56岁），74%为女性，55%为非西班牙裔白人。在参照期内，17.8%（95%置信区间[CI]，15.4 - 20.2%）发生了主要结局事件。在随后的术前12个月期间，风险保持不变（18.2%[95%CI，15.7 - 20.6%]；调整优势比[aOR]为1.02[95%CI，0.83 - 1.27]；P = 0.83）。在减肥手术后的第一个12个月期间，风险显著降低（10.5%[8.6 - 12.4%]；aOR为0.58[95%CI，0.45 - 0.74]；P < 0.0001）。同样，在减肥手术后的13 - 24个月期间，风险仍显著降低（12.9%[95%CI，10.8 - 15.0%]；aOR为0.71[95%CI，0.57 - 0.90]；P = 0.005）。相比之下，接受非减肥手术（即胆囊切除术、子宫切除术、脊柱融合术或乳房切除术）的肥胖患者的风险没有显著降低。
在这项基于人群的肥胖高血压成年患者研究中，我们发现减肥手术后高血压相关疾病的急性护理使用风险降低了40%。这些数据为大幅减重对高血压相关发病率的有效性提供了最佳证据，强调了在治疗肥胖高血压患者时讨论减肥方案的重要性。
