减肥手术在控制高血压中的作用：一项对代谢因素具有额外益处的系统评价和荟萃分析。
The role of bariatric surgery in hypertension control: a systematic review and meta-analysis with extended benefits on metabolic factors.
作者信息
Dastjerdi Parham, Pourfaraji Seyed Morteza, Shayesteh Hedieh, Maghsoudi Milad, Saeidi Sahar, Narimani Davani Delaram, Masouri Mohammad Mahdi, Parhizkar Roudsari Peyvand, Ojaghi Shirmard Fatemeh, Ebrahimi Pouya, Farooqi Mashood Ahmad, Hosseini Kaveh, Soleimani Hamidreza
机构信息
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Tehran University of Medical Sciences, Tehran, Iran.
出版信息
BMC Cardiovasc Disord. 2025 Mar 24;25(1):213. doi: 10.1186/s12872-025-04640-9.
BACKGROUND
By 2025, global obesity rates are projected to reach 16% in men and 21% in women, imposing a significant public health burden. Obesity is a major contributor to hypertension (HTN), exacerbating cardiovascular risks. This review and meta-analysis evaluated the effectiveness of non-surgical treatments versus bariatric surgery in managing hypertension among obese individuals.
METHODS
We searched PubMed, Scopus, Embase, and Cochrane databases up to May 2024. Randomized controlled trials (RCTs) comparing bariatric surgery (e.g., Roux-en-Y Gastric Bypass (RYGB), Sleeve gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Duodenal-jejunal bypass liner/Biliopancreatic diversion (DJBL/BPD)) with non-surgical interventions (e.g., lifestyle modifications, medications) in hypertensive obese patients were included. Primary outcomes were changes in systolic and diastolic blood pressure. Secondary outcomes included changes in fasting blood sugar (FBS), HbA1c, and lipid profiles. Data were synthesized using a random-effects model, with heterogeneity and publication bias assessed.
RESULTS
From 7,187 records, 29 studies involving 2,548 patients met the inclusion criteria. Bariatric surgery resulted in greater reductions in systolic (MD: -4.506 mmHg; 95% CI: -6.999 to -2.013) and diastolic (MD: -3.040 mmHg; 95% CI: -4.765 to -1.314) blood pressure compared to non-surgical interventions. Roux-en-Y gastric bypass had the most significant impact. Bariatric surgery also led to substantial reductions in FBS (MD: -30.444 mg/dl; 95% CI: -41.288 to -19.601), HbA1c (MD: -1.108%; 95% CI: -1.414 to -0.802), and triglycerides (MD: -39.746 mg/dl; 95% CI: -54.458 to -25.034), and increased HDL levels (MD: 7.387 mg/dl; 95% CI: 5.056 to 9.719). The quality of evidence was high for most outcomes, supporting these findings.
CONCLUSION
Bariatric surgery is superior to non-surgical treatments in managing obesity-related hypertension and metabolic disorders. Reductions in blood pressure, glycemic indexes, and lipid profiles highlight bariatric surgery's critical role in improving cardiovascular health and metabolic outcomes in obese hypertensive patients.
背景
预计到2025年，全球男性肥胖率将达到16%，女性肥胖率将达到21%，这将带来巨大的公共卫生负担。肥胖是高血压（HTN）的主要促成因素，会加剧心血管疾病风险。本综述和荟萃分析评估了非手术治疗与减肥手术在肥胖个体高血压管理中的有效性。
方法
我们检索了截至2024年5月的PubMed、Scopus、Embase和Cochrane数据库。纳入了比较减肥手术（如Roux-en-Y胃旁路术（RYGB）、袖状胃切除术（SG）、腹腔镜可调节胃束带术（LAGB）、十二指肠空肠旁路内衬/胆胰分流术（DJBL/BPD））与非手术干预措施（如生活方式改变、药物治疗）对高血压肥胖患者影响的随机对照试验（RCT）。主要结局是收缩压和舒张压的变化。次要结局包括空腹血糖（FBS）、糖化血红蛋白（HbA1c）和血脂谱的变化。数据采用随机效应模型进行综合分析，并评估异质性和发表偏倚。
结果
从7187条记录中，29项涉及2548例患者的研究符合纳入标准。与非手术干预相比，减肥手术导致收缩压（MD：-4.506 mmHg；95%CI：-6.999至-2.013）和舒张压（MD：-3.040 mmHg；95%CI：-4.765至-1.314）的降低幅度更大。Roux-en-Y胃旁路术的影响最为显著。减肥手术还导致FBS（MD：-30.444 mg/dl；95%CI：-41.288至-19.601）、HbA1c（MD：-1.108%；95%CI：-1.414至-0.802）和甘油三酯（MD：-39.746 mg/dl；95%CI：-54.458至-25.034）大幅降低，并使高密度脂蛋白水平升高（MD：7.387 mg/dl；95%CI：5.056至9.719）。大多数结局的证据质量较高，支持这些发现。
结论
在管理肥胖相关高血压和代谢紊乱方面，减肥手术优于非手术治疗。血压、血糖指数和血脂谱的降低凸显了减肥手术在改善肥胖高血压患者心血管健康和代谢结局方面的关键作用。
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