Gastric bypass is superior to medical management alone at reducing antihypertensive medications while also reducing weight and improving other health measures in obese hypertensive patients according to research presented at the 2017 American Heart Association Scientific Sessions and published in Circulation.

The GATEWAY (GAstric bypass surgery to TrEat patients With steAdy hYpertension) clinical trial examined the impact of bariatric surgery on hypertension control. It was a randomized (concealed), single-center, phase III, parallel design of 100 participants aged (average age 44, average BMI 36.9 ± 2.7 kg/m²), with essential arterial hypertension, using at least 2 drugs at optimal doses or more than two in optimal and/or moderate doses.

The primary endpoint was reduction of at least 30% of the total antihypertensive drugs, while maintaining controlled blood pressure (BP) levels (<140x90mmHg) at 12 months.  Secondary endpoints were weight reduction, percentage of patients with controlled BP levels without medication, C-reactive protein, glycated hemoglobin, triglyceride and LDL- cholesterol levels.

"Most patients in the gastric-bypass group achieved the primary endpoint in the first month of the postoperative period," noted Dr. Carlos Aurelio Schiavon of the Research Institute, Heart Hospital, São Paulo, Brazil.  That seems to mean that "something more is happening beyond weight loss."

Patients were randomized to either Roux-en-Y Gastric Bypass combined with optimized medical treatment or optimized medical treatment alone.  Patients randomly selected for gastric bypass plus medical treatment overwhelmingly (83.7%) reached the primary endpoint of reduction of total antihypertensive drugs by at least 30% while maintaining controlled blood pressure levels at 12 months versus patients selected for medical treatment alone (12.8%) (incidence rate ratio [95% CI] 6.55 [3.07; 13.98] P<0.001).

At 12 months, 51% of patients in the gastric bypass group remained with controlled blood pressure without medications.  No patient submitted to optimized medical treatment was free of anti-hypertensive drugs at 12 months.

GATEWAY joins other studies in a mounting body of evidence that bariatric surgery is an effective treatment for obesity and obesity-related diseases, such as hypertension.

The study was supported by Ethicon.