Several studies have shown that
metabolic surgery is associated with remission of diabetes and
hypertension. In terms of diabetes, factors such as duration,
insulin use,
weight loss, and age have been shown to contribute to the likelihood of remission. Such factors have not been determined for
hypertension. The aim of this study was to evaluate factors associated with the remission and relapse of
hypertension after
metabolic surgery, as well as the risk for major adverse cardiovascular event (
MACE) and mortality in patients with and without remission.
METHODS AND FINDINGS: All adults who underwent
metabolic surgery between January 2007 and June 2016 were identified in the nationwide Scandinavian
Obesity Surgery Registry (SOReg). Through cross-linkage with the Swedish Prescribed
Drug Register, Patient Register, and Statistics Sweden, individual data on prescriptions, inpatient and outpatient diagnoses, and mortality were retrieved. Of the 15,984 patients with pharmacologically treated
hypertension, 6,286 (39.3%) were in remission at 2 years. High
weight loss and male sex were associated with higher chance of remission, while duration, number of
antihypertensive drugs, age, body mass index (BMI),
cardiovascular disease, and
dyslipidemia were associated with lower chance. After adjustment for age, sex, BMI, comorbidities, and education, the cumulative probabilities of MACEs (2.8% versus 5.7%, adjusted odds ratio (OR) 0.60, 95% confidence interval (CI) 0.47 to 0.77, p < 0.001) and all-cause mortality (4.0% versus 8.0%, adjusted OR 0.71, 95% CI 0.57 to 0.88, p = 0.002) were lower for patients being in remission at 2 years compared with patients not in remission, despite relapse of
hypertension in 2,089 patients (cumulative probability 56.3%) during 10-year follow-up. The main limitations of the study were missing information on nonpharmacological treatment for
hypertension and the observational study design.
CONCLUSIONS: In this study, we observed an association between high postoperative
weight loss and male sex with better chance of remission, while we observed a lower chance of remission depending on disease severity and presence of other metabolic comorbidities. Patients who achieved remission had a halved risk of
MACE and death compared with those who did not. The results suggest that in patients with
severe obesity and
hypertension,
metabolic surgery should not be delayed.