Three-Year Outcomes of Bariatric Surgery in Patients With Obesity and Hypertension A Randomized Clinical Trial
Nenhuma Miniatura disponível
Citações na Scopus
56
Tipo de produção
article
Data de publicação
2020
Título da Revista
ISSN da Revista
Título do Volume
Editora
AMER COLL PHYSICIANS
Autores
SCHIAVON, Carlos A.
BHATT, Deepak L.
IKEOKA, Dimas
V, Eliana Santucci
SANTOS, Renato Nakagawa
DAMIANI, Lucas P.
OLIVEIRA, Juliana D.
V, Rachel Helena Machado
HALPERN, Helio
MONTEIRO, Frederico L. J.
Citação
ANNALS OF INTERNAL MEDICINE, v.173, n.9, p.685-+, 2020
Resumo
Background: Midterm effects of bariatric surgery on patients with obesity and hypertension remain uncertain. Objective: To determine the 3-year effects of Roux-en-Y gastric bypass (RYGB) on blood pressure (BP) compared with medical therapy (MT) alone. Design: Randomized clinical trial. (ClinicalTrials.gov: NCT01784848) Setting: Investigator-initiated study at Heart Hospital (HCor), Sao Paulo, Brazil. Participants: Patients 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/m(2) were randomly assigned (1:1 ratio). Intervention: RYGB plus MT or MT alone. Measurements: The 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). Results: Among 100 patients (76% female; mean BMI, 36.9 kg/m(2) [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 B-12 and 2 patients required reoperation. Limitation: Single-center, nonblinded trial. Conclusion: RYGB is an effective strategy for midterm BP control and hypertension remission, with fewer medications required in patients with hypertension and obesity.
Palavras-chave
Referências
- Adams TD, 2017, NEW ENGL J MED, V377, P1143, DOI 10.1056/NEJMoa1700459
- Adams TD, 2010, OBESITY, V18, P121, DOI 10.1038/oby.2009.178
- Arterburn DE, 2015, JAMA-J AM MED ASSOC, V313, P62, DOI 10.1001/jama.2014.16968
- Benjamin EJ, 2019, CIRCULATION, V139, pE56, DOI 10.1161/CIR.0000000000000659
- Bhatt DL, 2019, J AM COLL CARDIOL, V74, P261, DOI 10.1016/j.jacc.2019.04.058
- Bhatt DL, 2014, NEW ENGL J MED, V370, P1393, DOI 10.1056/NEJMoa1402670
- Borisenko O, 2018, BRIT J SURG, V105, P1328, DOI 10.1002/bjs.10857
- Borisenko O, 2015, OBES SURG, V25, P1559, DOI 10.1007/s11695-014-1567-5
- Calhoun DA, 2008, CIRCULATION, V117, pE510, DOI 10.1161/CIRCULATIONAHA.108.189141
- Chowdhury R, 2013, EUR HEART J, V34, P2940, DOI 10.1093/eurheartj/eht295
- Courcoulas AP, 2013, JAMA-J AM MED ASSOC, V310, P2416, DOI 10.1001/jama.2013.280928
- Fagard RH, 2009, J HUM HYPERTENS, V23, P645, DOI 10.1038/jhh.2009.9
- Grupo de Trabalho MAPA, 2011, J Bras Nefrol, V33, P365
- Gu QP, 2012, CIRCULATION, V126, P2105, DOI 10.1161/CIRCULATIONAHA.112.096156
- Hallersund P, 2012, PLOS ONE, V7, DOI 10.1371/journal.pone.0049696
- Ikramuddin S, 2018, JAMA-J AM MED ASSOC, V319, P266, DOI 10.1001/jama.2017.20813
- Jakobsen GS, 2018, JAMA-J AM MED ASSOC, V319, P291, DOI 10.1001/jama.2017.21055
- James WPT, 2010, NEW ENGL J MED, V363, P905, DOI 10.1056/NEJMoa1003114
- Kumbhani DJ, 2013, EUR HEART J, V34, P1204, DOI 10.1093/eurheartj/ehs368
- Liang ZW, 2013, DIABETES RES CLIN PR, V101, P50, DOI 10.1016/j.diabres.2013.04.005
- Mingrone G, 2015, LANCET, V386, P964, DOI 10.1016/S0140-6736(15)00075-6
- O'Neil PM, 2018, LANCET, V392, P637, DOI 10.1016/S0140-6736(18)31773-2
- Pareek M, 2019, CIRC RES, V124, P1009, DOI 10.1161/CIRCRESAHA.118.313320
- Pareek M, 2018, J AM COLL CARDIOL, V71, P670, DOI 10.1016/j.jacc.2017.12.014
- Pi-Sunyer X, 2015, NEW ENGL J MED, V373, P11, DOI 10.1056/NEJMoa1411892
- Reisin E, 2014, J HYPERTENS, V32, P1503, DOI 10.1097/HJH.0000000000000204
- Schauer PR, 2017, NEW ENGL J MED, V376, P641, DOI 10.1056/NEJMoa1600869
- Schauer PR, 2016, DIABETES CARE, V39, P902, DOI 10.2337/dc16-0382
- Schauer PR, 2014, NEW ENGL J MED, V370, P2002, DOI 10.1056/NEJMoa1401329
- Schauer PR, 2012, NEW ENGL J MED, V366, P1567, DOI 10.1056/NEJMoa1200225
- Schiavon CA, 2019, HYPERTENSION, V73, P571, DOI 10.1161/HYPERTENSIONAHA.118.12290
- Schiavon CA, 2018, CIRCULATION, V137, P1132, DOI 10.1161/CIRCULATIONAHA.117.032130
- Schiavon CA, 2014, BMJ OPEN, V4, DOI 10.1136/bmjopen-2014-005702
- Topol EJ, 2010, LANCET, V376, P517, DOI 10.1016/S0140-6736(10)60935-X
- U.S. Food and Drug Administration, 2020, FDA REQ WITHDR WEIGH
- van Buuren S, 2011, J STAT SOFTW, V45, P1
- Whelton PK, 2018, HYPERTENSION, V71, pE13, DOI 10.1161/HYP.0000000000000065
- 2017, NEW ENGL J MED, V377, P13, DOI [10.1056/NEJMoa1614362, DOI 10.1056/NEJMoa1614362]