Hypertension, commonly known as high blood pressure, is a global health concern that often co-occurs with obesity. Given the link between excess weight and high blood pressure, various treatment strategies are explored. Bariatric surgery is an intervention for individuals with obesity-related hypertension, addressing obesity and improving blood pressure control.
How Bariatric Surgery Impacts Blood Pressure
Bariatric surgery improves blood pressure through several physiological changes. A primary factor is significant weight loss, as a reduction of even one percent in body weight can lead to a decrease of one millimeter of mercury in systolic blood pressure and two millimeters of mercury in diastolic blood pressure. This weight reduction lessens the physical burden on the cardiovascular system.
Improved insulin sensitivity also plays a role, as insulin resistance is linked to increased sodium reabsorption by the kidneys and heightened sympathetic nervous system activity, contributing to higher blood pressure. Changes in gut hormones, such as glucagon-like peptide-1 (GLP-1) and peptide YY, are observed rapidly after surgery and may influence kidney function, promoting diuresis and natriuresis (excretion of sodium and water). Alterations in the gut microbiota and reduced systemic inflammation, which can cause arterial stiffness, also contribute to blood pressure improvement.
Common Bariatric Procedures for Hypertension
Common bariatric surgeries for hypertension are Roux-en-Y gastric bypass and sleeve gastrectomy.
Roux-en-Y gastric bypass creates a small stomach pouch and reroutes a section of the small intestine. This reduces food intake and alters nutrient absorption, leading to weight loss. The procedure also impacts gut hormone secretion and may decrease intra-abdominal pressure on the kidneys, which can deactivate the renin-angiotensin-aldosterone system, a hormonal system involved in blood pressure regulation.
Sleeve gastrectomy, a restrictive procedure, removes a large portion of the stomach to create a smaller, tube-shaped stomach. This limits food intake, promoting satiety. Both procedures contribute to hypertension improvement through sustained weight loss and the metabolic changes they induce, such as improved insulin sensitivity and reduced inflammation.
Patient Eligibility and Outcomes
Patient selection for bariatric surgery in hypertension management follows Body Mass Index (BMI) guidelines. Individuals with a BMI of 40 kg/m² or higher are considered. Also, those with a BMI between 35 and 39.9 kg/m² who have serious health conditions like hypertension that could benefit from weight loss. For some, especially those with type 2 diabetes diagnosed within the last decade, a BMI of 30 kg/m² or more may qualify them.
Bariatric surgery has demonstrated effectiveness in reducing blood pressure, decreasing the need for antihypertensive medications, and leading to hypertension remission. An analysis of 18 trials showed surgical patients were nearly three times more likely to achieve blood pressure remission, defined as blood pressure below 140/90 mmHg without medication. Over a one-to-five-year follow-up, surgical patients were seven times more likely to reduce the number of medications needed to manage their blood pressure. Remission rates at five years can be 60% for surgical patients, compared to 14% in control groups.
Comprehensive Care and Long-Term Management
Bariatric surgery is a component of a broader, ongoing treatment plan for hypertension and overall health. A pre-operative evaluation is a necessary step, ensuring patients are prepared for the surgical process. Following the procedure, adherence to dietary and lifestyle modifications is important.
This includes healthy eating habits and regular physical activity to support sustained weight loss and blood pressure control. Patients must commit to regular follow-up appointments with their healthcare team to monitor progress and adjust medications as needed. Ongoing medical monitoring ensures blood pressure remains well-controlled and potential long-term complications are addressed. Adherence to medical advice and lifestyle changes is important for sustained blood pressure control and overall well-being after surgery.