Fisher David P, Liu Liyan, Arterburn David, Coleman Karen J, Courcoulas Anita, Haneuse Sebastien, Johnson Eric, Li Robert A, Theis Mary Kay, Taylor Brianna, Fischer Heidi, Cooper Julie, Herrinton Lisa J
Kaiser Permanente Northern California, Oakland, CA.
Kaiser Permanente Washington Health Research Institute, Seattle, WA.
Ann Surg Open. 2022 Apr 27;3(2):e158. doi: 10.1097/AS9.0000000000000158. eCollection 2022 Jun.
To compare hypertension remission and relapse after bariatric surgery compared with usual care.
The effect of Roux-en-Y gastric bypass and sleeve gastrectomy on hypertension remission and relapse has not been studied in large, multicenter studies over long periods and using clinical blood pressure (BP) measurements.
This retrospective cohort study was set in Kaiser Permanente Washington, Northern California, and Southern California. Participants included 9432 patients with hypertension 21-65 years old who underwent bariatric surgery during 2005-2015 and 66,651 nonsurgical controls matched on an index date on study site, age, sex, race/ethnicity, body mass index, comorbidity burden, diabetes status, diastolic and systolic BP, and number of antihypertensive medications.
At 5 years, the unadjusted cumulative incidence of hypertension remission was 60% (95% confidence interval [CI], 58-61%) among surgery patients and 14% (95% CI, 13-14%) among controls. At 1 year, the adjusted hazard ratio for the association of bariatric surgery with hypertension remission was 10.24 (95% CI, 9.61-10.90). At 5 years, the adjusted hazard ratio was 2.10 (95% CI, 1.57-2.80). Among those who remitted, the unadjusted cumulative incidence of relapse at 5 years after remission was 54% (95% CI, 51-56%) among surgery patients and 78% (95% CI 76-79%) among controls, although the adjusted hazard ratio was not significant (hazard ratio, 0.71; 95% CI, 0.46-1.08).
Bariatric surgery was associated with greater hypertension remission than usual care suggesting that bariatric surgery should be discussed with patients with severe obesity and hypertension. Surgical patients who experience remission should be monitored carefully for hypertension relapse.
比较减重手术后高血压缓解和复发情况与常规治疗的差异。
Roux-en-Y胃旁路手术和袖状胃切除术对高血压缓解和复发的影响尚未在长期的大型多中心研究中使用临床血压测量进行研究。
这项回顾性队列研究在华盛顿、北加利福尼亚和南加利福尼亚的凯撒医疗集团进行。参与者包括9432名年龄在21至65岁之间、在2005年至2015年期间接受减重手术的高血压患者，以及66651名非手术对照者，这些对照者在研究地点、年龄、性别、种族/族裔、体重指数、合并症负担、糖尿病状态、舒张压和收缩压以及抗高血压药物数量等索引日期上进行了匹配。
在5年时，手术患者中高血压缓解的未调整累积发生率为60%（95%置信区间[CI]，58 - 61%），对照者中为14%（95% CI，13 - 14%）。在1年时，减重手术与高血压缓解关联的调整后风险比为10.24（95% CI，9.61 - 10.90）。在5年时，调整后风险比为2.10（95% CI，1.57 - 2.80）。在缓解的患者中，缓解后5年复发的未调整累积发生率在手术患者中为54%（95% CI，51 - 56%），对照者中为78%（95% CI 76 - 79%），尽管调整后风险比不显著（风险比，0.71；95% CI，0.46 - 1.08）。
减重手术与比常规治疗更大的高血压缓解相关，这表明对于重度肥胖和高血压患者应讨论减重手术。经历缓解的手术患者应密切监测高血压复发情况。
