Bariatric Surgery for Resistant Hypertension: Working in Progress!
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RESISTANT HYPERTENSION (L DRAGER, SECTION EDITOR)
Bariatric Surgery for Resistant Hypertension: Working in Progress! Carlos A. Schiavon 1,2 & Andrea Pio-Abreu 3 & Luciano F. Drager 3,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To discuss the recent evidence pointing the benefits of the bariatric surgery on blood pressure control in patients with obesity and hypertension. Particular focus is devoted to discuss the potential impact on resistant hypertension. Recent Findings Growing evidence suggest that bariatric surgery promotes not only a significant reduction in the antihypertensive medication while maintained blood pressure control but also a significant proportion of hypertension remission as compared to the usual care. In a sub-analysis of the GATEWAY trial using both office and 24–h ambulatory blood pressure monitoring, the prevalence of resistant hypertension significantly decreased after 12 months in the surgical group whereas the numbers remained stable in the control group. Summary Despite the lack of robust evidence, preliminary findings underscore the strong need to explore the potential role of bariatric surgery on resistant hypertension in patients with obesity. This statement is justified not only for the burden of obesity in this scenario but also for the unmet demands in managing resistant hypertension appropriately by multiple drug-therapy or the lack of real utility of procedures like renal denervation and carotid baroreflex activation. Keywords Bariatric surgery . Obesity . Hypertension . Resistant hypertension . Treatment
Introduction Resistant Hypertension (RH) is defined as a special subtype of hypertension (HTN) that remains uncontrolled despite using three antihypertensives at optimal doses, including one diuretic, or that is controlled on four or more classes [1••]. Using the traditional cut-off of < 140/90 mmHg, the estimated prevalence of RH among treated hypertensives is approximately 12–15% [2•, 3–5], being obviously higher when adopting the criteria proposed by the new American Hypertension Guidelines [1••]. RH certainly represents an important public health problem. Previous studies using ambulatory blood This article is part of the Topical Collection on Resistant Hypertension * Carlos A. Schiavon [email protected] 1
Bariatric Surgery Center, BP Hospital, Sao Paulo, Brazil
2
Research Institute, Heart Hospital (HCor), Abilio Soares St, 250, 12th Floor, Sao Paulo, SP 04004-050, Brazil
3
Hypertension Unit, Renal Division, University of São Paulo Medical School, São Paulo, Brazil
4
Heart Institute (InCor), Hypertension Unit, University of São Paulo Medical School, São Paulo, Brazil
pressure (BP) monitoring (ABPM), showed that there is an almost twofold increased risk of cardiovascular disease (CVD) events in patients with true RH compared with those with non-RH [6, 7]. RH also has increased risk of developing end-stage renal disease [8]. RH has been associated with target-organ damage and multiple comorbidities, includi
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