Passman Jesse E, Bader Amanda, Mahmud Nadim, Dumon Kristoffel R, Wachtel Heather, Zheng Feibi, Cohen Jordana B
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA.
J Hum Hypertens. 2025 Aug 20. doi: 10.1038/s41371-025-01063-z.
Metabolic and bariatric surgery (MBS) is an effective treatment for obesity and metabolic syndrome. Evidence regarding the impact of MBS on hypertension outcomes is limited by short-term follow-up. Thus, this retrospective cohort study was designed to compare blood pressure (BP) control, number of antihypertensive medications (AHMs), development of apparent treatment resistant hypertension (ATRH), and remission of hypertension between patients treated with and without MBS. Adults with BMI ≥ 35 kg/m and a new diagnosis of hypertension receiving care within the Veterans Health Administration system from 2000-2019 were included. Generalized estimating equations and time-updated Cox models with inverse probability of treatment weighting to address time-updated confounding were used. Over a median follow-up of 5.1 years, 183702 patients with BMI ≥ 35 kg/m and hypertension were managed medically and 3965 were managed surgically. At baseline, those who underwent MBS were more likely to be women than men (22 vs. 10%). Patients treated surgically demonstrated significantly better BP control over time, with an average 5.4 mm Hg (95% CI 4.9-5.9) lower systolic BP and 1.8 mm Hg (95% CI 1.5-2.1) lower diastolic BP. Compared to patients treated medically, those who received MBS had 32% higher likelihood of complete AHM discontinuation (95% CI 1.23-1.42). Patients treated with MBS were 14% less likely to develop ATRH (95% CI 0.78-0.95). Overall, among patients with obesity and hypertension, treatment with MBS was associated with durably improved BP control compared to medical management, including lower systolic and diastolic BPs, higher AHM cessation, and lower rates of ATRH.
代谢与减重手术（MBS）是治疗肥胖症和代谢综合征的有效方法。关于MBS对高血压结局影响的证据因短期随访而受限。因此，本回顾性队列研究旨在比较接受和未接受MBS治疗的患者之间的血压（BP）控制情况、抗高血压药物（AHM）数量、明显治疗抵抗性高血压（ATRH）的发生情况以及高血压缓解情况。纳入了2000年至2019年在退伍军人健康管理系统内接受治疗、BMI≥35 kg/m且新诊断为高血压的成年人。使用广义估计方程和具有治疗权重逆概率的时间更新Cox模型来处理时间更新的混杂因素。在中位随访5.1年期间，对183702例BMI≥35 kg/m且患有高血压的患者进行了药物治疗，对3965例患者进行了手术治疗。在基线时，接受MBS治疗的患者中女性比男性更常见（22%对10%）。随着时间的推移，接受手术治疗的患者表现出明显更好的血压控制，收缩压平均降低5.4 mmHg（95%CI 4.9 - 5.9），舒张压平均降低1.8 mmHg（95%CI 1.5 - 2.1）。与接受药物治疗的患者相比，接受MBS治疗的患者完全停用AHM的可能性高32%（95%CI 1.23 - 1.42）。接受MBS治疗的患者发生ATRH的可能性低14%（95%CI 0.78 - 0.95）。总体而言，在肥胖和高血压患者中，与药物治疗相比，MBS治疗与持久改善的血压控制相关，包括更低的收缩压和舒张压、更高的AHM停用率以及更低的ATRH发生率。
