Comparing remission and recurrence of hypertension after bariatric surgery: vertical sleeve gastrectomy versus Roux-en-Y gastric bypass

Abstract

Background: Bariatric surgery results in rapid weight loss and resolution of many co-morbidities including hypertension.

Objectives: To investigate the association of the 2 most common bariatric surgical procedures, vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB), with sustained remission from hypertension, and evaluate other independent predictors of sustained remission.

Setting: Privately insured patients with hypertension in the United States undergoing bariatric surgery.

Methods: A cohort of hypertensive bariatric patients was created using detailed inclusion and exclusion criteria. Remission was defined as no refill of antihypertensive medication for 30 days after patients' medication was expected to run out, and recurrence as medication refill after at least 90 days of remission.

Results: Of 7006 patients in our cohort, 5874 experienced remission of their hypertension (83.8%). 745 of the 5874 (12.7%) patients later experienced recurrence. The adjusted hazard ratio of remission for VSG compared with RYGB was 1.06 (95% confidence interval [CI]; 1.0, 1.11). The adjusted hazard ratio of recurrence for VSG compared with RYGB was .84 (95% CI; .71, .97). A higher number of medications at the time of surgery was associated with a decreased likelihood of remission and an increased risk of recurrence of hypertension.

Conclusion: There was no difference in the likelihood of remission of hypertension between VSG and RYGB. The number of medications at the time of surgery was the most important predictor of remission and recurrence of hypertension after surgery.

Keywords: Hypertension; Recurrence; Remission; Roux-en-Y gastric bypass; Vertical sleeve gastrectomy.