Long-term impact of bariatric surgery on hypertension control and remission: A meta-analysis of randomized controlled trials

Bariatric/metabolic surgery is a highly effective intervention for obesity and its related metabolic complications. However, evidence regarding its impact on hypertension outcomes remains limited. This study aims to synthesize data from key randomized controlled trials (RCTs) to assess the long-term effects of bariatric/metabolic surgery compared to medical or lifestyle management on hypertension remission and control in individuals with obesity. We did a systematic literature search on PubMed, ScienceDirect, Google Scholar, and Clinicaltrials.gov for relevant RCTs from inception until April 2024. Statistical analyses were done using RevMan 5.4 with a random effects model. The study protocol is registered in PROSPERO (CRD42024527369). The study comprised 19 RCTs involving 1098 individuals with obesity (64.6 % women) with a mean BMI of 38 kg/ m 2 and an average follow-up duration of 1 to 5 years. On pooled analysis, there was a statistically significant difference in the rate of hypertension remission between patients who underwent bariatric/metabolic surgery versus patients on medical/lifestyle management with an RR of 2.77 (95 % CI: 1.26 to 6.10, p = 0.01). Additionally, a substantial reduction in the use of antihypertensive medications while maintaining controlled blood pressure was observed (RR: 7.10; 95 % CI: 4.38 to 11.51, p < 0.00001), with no heterogeneity. Bariatric/metabolic surgery also significantly improved systolic blood pressure control (WMD:3.81; 95 % CI:5.55 to -2.07, p < 0.0001). Bariatric/metabolic surgery demonstrates significant effectiveness in managing obesity-related hypertension, providing long-term remission, and improving blood pressure control. It reduces the dependence on antihypertensive medications, offering a durable solution that addresses both obesity and hypertension. This highlights bariatric/metabolic surgery as an effective treatment option for individuals with obesity, with the potential to improve both metabolic and cardiovascular health outcomes. Lay Summary: Bariatric/metabolic surgery (weight-loss surgery), a medical procedure designed to help people lose weight, has been shown to be an effective treatment not just for obesity but also for related health problems, such as high blood pressure (hypertension). Our analysis, which looked at 18 studies, found that people who had bariatric/metabolic surgery experienced better control over their blood pressure and were able to reduce the use of blood pressure medications. In other words, bariatric/metabolic surgery can improve blood pressure, leading to better health outcomes and less reliance on medications for managing hypertension.