• Carlos A Schiavon, Deepak L Bhatt, Dimas Ikeoka, Eliana V Santucci, Renato Nakagawa Santos, Lucas P Damiani, Juliana D Oliveira, Rachel Helena V Machado, Helio Halpern, Frederico L J Monteiro, Patricia M Noujaim, Ricardo V Cohen, Marcio G de Souza, Celso Amodeo, Luiz A Bortolotto, Otavio Berwanger, Alexandre B Cavalcanti, and Luciano F Drager.
• HCor Research Institute, São Paulo, Brazil (C.A.S., E.V.S., R.N.S., L.P.D., J.D.O., R.H.M., A.B.C.).
• Ann. Intern. Med. 2020 Nov 3; 173 (9): 685-693.

BackgroundMidterm effects of bariatric surgery on patients with obesity and hypertension remain uncertain.ObjectiveTo determine the 3-year effects of Roux-en-Y gastric bypass (RYGB) on blood pressure (BP) compared with medical therapy (MT) alone.DesignRandomized clinical trial. (ClinicalTrials.gov: NCT01784848).SettingInvestigator-initiated study at Heart Hospital (HCor), São Paulo, Brazil.ParticipantsPatients with hypertension receiving at least 2 medications at maximum doses or more than 2 medications at moderate doses and with a body mass index (BMI) between 30.0 and 39.9 kg/m2 were randomly assigned (1:1 ratio).InterventionRYGB plus MT or MT alone.MeasurementsThe primary outcome was at least a 30% reduction in total number of antihypertensive medications while maintaining BP less than 140/90 mm Hg. Key secondary outcomes were number of antihypertensive medications, hypertension remission, and BP control according to current guidelines (<130/80 mm Hg).ResultsAmong 100 patients (76% female; mean BMI, 36.9 kg/m2 [SD, 2.7]), 88% from the RYGB group and 80% from the MT group completed follow-up. At 3 years, the primary outcome occurred in 73% of patients from the RYGB group compared with 11% of patients from the MT group (relative risk, 6.52 [95% CI, 2.50 to 17.03]; P < 0.001). Of the randomly assigned participants, 35% and 31% from the RYGB group and 2% and 0% from the MT group achieved BP less than 140/90 mm Hg and less than 130/80 mm Hg without medications, respectively. Median (interquartile range) number of medications in the RYGB and MT groups at 3 years was 1 (0 to 2) and 3 (2.8 to 4), respectively (P < 0.001). Total weight loss was 27.8% and -0.1% in the RYGB and MT groups, respectively. In the RYGB group, 13 patients developed hypovitaminosis B12 and 2 patients required reoperation.LimitationSingle-center, nonblinded trial.ConclusionRYGB is an effective strategy for midterm BP control and hypertension remission, with fewer medications required in patients with hypertension and obesity.Primary Funding SourceEthicon, represented in Brazil by Johnson & Johnson do Brasil.

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