Impact of Metabolic and Bariatric Surgery on Antihypertensive Medication Use and Hypertension Management

Metabolic and bariatric surgery (MBS) is considered as the most efficient and durable treatment for obesity. The current study aimed to compare the patterns of antihypertensive medication (AHM) use between obese individuals who underwent MBS and those who did not.

The study included adults with a body mass index of ≥35 kg/m² using the Merative Database. Patients who received MBS were matched 1:1 with those who did not, based on demographic and clinical characteristics and AHM usage. Monthly AHM use was analyzed over three years following the index date using generalized estimating equations. Subanalyses evaluated rates of AHM discontinuation, initiation, and apparent treatment-resistant hypertension.

The results revealed the following:

• The primary cohort consisted of 43,206 adults who underwent MBS, paired with an equal number who did not. 
• Those treated with MBS exhibited significantly lower rates of AHM use compared to those without surgery (31% vs. 15% at 12 months; 32% vs. 17% at 36 months). 
• Among baseline AHM users, 42% of MBS patients discontinued AHM versus only 7% of those treated medically.
• Additionally, the risk of apparent treatment-resistant hypertension was 3.41 times higher (95% CI, 2.91–4.01) in patients who did not undergo MBS. 
• Among those without hypertension, 7% of MBS patients required AHM at 2 years compared to 21% in the non-MBS group.

To conclude, MBS is associated with lower rates of AHM use, higher rates of AHM discontinuation, and lower rates of AHM initiation among patients not taking AHM, suggestive that MBS is both an efficient treatment and a preventative measure for hypertension.

Source: Passman JE, Wall-Wieler E, Liu Y, Zheng F, Cohen JB. Antihypertensive Medication Use Trajectories After Bariatric Surgery: A Matched Cohort Study. Hypertension. 2024 Aug;81(8):1737-1746. doi: 10.1161/HYPERTENSIONAHA.124.23054. Epub 2024 Jun 4. PMID: 38832510; PMCID: PMC11251508.