Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
PLoS Med. 2020 Sep 15;17(9):e1003307. doi: 10.1371/journal.pmed.1003307. eCollection 2020 Sep.
Hypertension, together with obesity, is a leading cause of mortality and disability. Whilst metabolic surgery offers remission of several metabolic comorbidities, the effect for patients with hypertension remains controversial. The objective of the present study was to evaluate the effect of metabolic surgery on cardiovascular events and mortality on patients with morbid obesity (body mass index [BMI] ≥ 35 kg/m2) and hypertension.
We conducted a matched cohort study of 11,863 patients with morbid obesity and pharmacologically treated hypertension operated on with metabolic surgery and a matched non-operated-on control group of 26,199 subjects with hypertension (matched by age, sex, and area of residence) of varied matching ratios from 1:1 to 1:9, using data from the Scandinavian Obesity Surgery Register (SOReg), the Swedish National Patient Registers (NPR) for in-hospital and outpatient care, the Swedish Prescribed Drug Register, and Statistics Sweden. The main outcome was major adverse cardiovascular event (MACE), defined as first occurrence of acute coronary syndrome (ACS) event, cerebrovascular event, fatal cardiovascular event, or unattended sudden cardiac death. The mean age in the study group was 52.1 ± 7.46 years, with 65.8% being women (n = 7,810), and mean BMI was 41.9 ± 5.43 kg/m2. MACEs occurred in 379 operated-on patients (3.2%) and 1,125 subjects in the control group (4.5%). After adjustment for duration of hypertension, comorbidities, and education, a reduction in risk was seen in the metabolic surgery group (adjusted hazard ratio [HR] 0.73, 95% confidence intervals [CIs] 0.64-0.84, P < 0.001). The surgery group had lower risk for ACS events (adjusted HR 0.52, 95% CI 0.41-0.66, P < 0.001) and a tendency towards lower risk for cerebrovascular events (adjusted HR 0.81, 95% CI 0.63-1.01, P = 0.060) compared with controls. The main limitations with the study were the lack of information on BMI and history of smoking in the control group and the nonrandomised study design.
Metabolic surgery on patients with morbid obesity and pharmacologically treated hypertension was associated with lower risk for MACEs and all-cause mortality compared with age- and sex-matched controls with hypertension from the general population.
高血压与肥胖一起是导致死亡和残疾的主要原因。虽然代谢手术可以缓解多种代谢合并症，但对于高血压患者的效果仍存在争议。本研究的目的是评估代谢手术对病态肥胖（体重指数[BMI]≥35kg/m2）合并高血压患者的心血管事件和死亡率的影响。
我们对 11863 名接受代谢手术的病态肥胖合并药物治疗的高血压患者进行了匹配队列研究，并与 26199 名匹配的未手术对照组（按年龄、性别和居住地区匹配）进行了匹配，匹配比例从 1:1 到 1:9。使用数据来自斯堪的纳维亚肥胖手术登记处（SOReg）、瑞典国家患者登记处（NPR）的住院和门诊护理、瑞典处方药物登记处和瑞典统计局。主要结局是主要不良心血管事件（MACE），定义为急性冠状动脉综合征（ACS）事件、脑血管事件、致命心血管事件或未经处理的突发性心脏死亡的首次发生。研究组的平均年龄为 52.1±7.46 岁，其中 65.8%为女性（n=7810），平均 BMI 为 41.9±5.43kg/m2。379 名手术患者（3.2%）和 1125 名对照组患者（4.5%）发生 MACE。在调整高血压持续时间、合并症和教育程度后，手术组的风险降低（调整后的风险比[HR]0.73，95%置信区间[CI]0.64-0.84，P<0.001）。与对照组相比，手术组 ACS 事件的风险较低（调整后的 HR 0.52，95%CI 0.41-0.66，P<0.001），脑血管事件的风险也有降低的趋势（调整后的 HR 0.81，95%CI 0.63-1.01，P=0.060）。该研究的主要局限性是对照组缺乏 BMI 和吸烟史信息，以及非随机研究设计。
与普通人群中年龄和性别匹配的高血压对照组相比，代谢手术治疗病态肥胖合并药物治疗的高血压患者的 MACE 和全因死亡率风险较低。
