The role of bariatric surgery in hypertension control: a systematic review and meta-analysis with extended benefits on metabolic factors

Abstract

BackgroundBy 2025, global obesity rates are projected to reach 16 in men and 21 in women, imposing a significant public health burden. Obesity is a major contributor to hypertension (HTN), exacerbating cardiovascular risks. This review and meta-analysis evaluated the effectiveness of non-surgical treatments versus bariatric surgery in managing hypertension among obese individuals.MethodsWe searched PubMed, Scopus, Embase, and Cochrane databases up to May 2024. Randomized controlled trials (RCTs) comparing bariatric surgery (e.g., Roux-en-Y Gastric Bypass (RYGB), Sleeve gastrectomy (SG), Laparoscopic adjustable gastric banding (LAGB), Duodenal-jejunal bypass liner/Biliopancreatic diversion (DJBL/BPD)) with non-surgical interventions (e.g., lifestyle modifications, medications) in hypertensive obese patients were included. Primary outcomes were changes in systolic and diastolic blood pressure. Secondary outcomes included changes in fasting blood sugar (FBS), HbA1c, and lipid profiles. Data were synthesized using a random-effects model, with heterogeneity and publication bias assessed.ResultsFrom 7,187 records, 29 studies involving 2,548 patients met the inclusion criteria. Bariatric surgery resulted in greater reductions in systolic (MD: -4.506 mmHg; 95 CI: -6.999 to -2.013) and diastolic (MD: -3.040 mmHg; 95 CI: -4.765 to -1.314) blood pressure compared to non-surgical interventions. Roux-en-Y gastric bypass had the most significant impact. Bariatric surgery also led to substantial reductions in FBS (MD: -30.444 mg/dl; 95 CI: -41.288 to -19.601), HbA1c (MD: -1.108; 95 CI: -1.414 to -0.802), and triglycerides (MD: -39.746 mg/dl; 95 CI: -54.458 to -25.034), and increased HDL levels (MD: 7.387 mg/dl; 95 CI: 5.056 to 9.719). The quality of evidence was high for most outcomes, supporting these findings.ConclusionBariatric surgery is superior to non-surgical treatments in managing obesity-related hypertension and metabolic disorders. Reductions in blood pressure, glycemic indexes, and lipid profiles highlight bariatric surgery's critical role in improving cardiovascular health and metabolic outcomes in obese hypertensive patients.