Short‐ and Long‐Term Control of Hypertension After Bariatric Surgery: A 10‐Year Prospective Study

ABSTRACT Current guidelines support bariatric surgery (BS) as an effective treatment mainly for patients with severe obesity and poorly controlled hypertension. However, evidence in non‐severely obese Asian populations remains limited. This multicenter prospective cohort study included 248 Chinese patients with obesity and hypertension who underwent BS between 2010 and 2019 and were followed for up to 10 years. An exploratory mechanistic substudy ( n = 14) evaluated 24‐h ambulatory blood pressure (BP), various biomarkers, and urinary electrolytes before and after BS. Compared with baseline, adjusted mean systolic blood pressure (SBP) was lower by 16.4, 14.8, 15.1, 18.0, and 15.2 mmHg, while diastolic blood pressure (DBP) decreased by 11.4, 9.1, 9.9, 10.5, and 11.4 mmHg at 3 months, 6 months, and 1, 5, 10 years postoperatively. During postoperative Days 1 to 7 (POD1‐7), mean SBP and DBP dropped by 8.6 and 10.4 mmHg, and the proportion achieving BP < 140/90 mmHg increased to 62.9% and remained at 70.8% even 10 years later. The substudy has observed that early BP reduction was accompanied by increased electrolytes and water excretion, as well as a transient suppression of renin‐angiotensin‐aldosterone system (RAAS)‐related biomarkers, providing a direction for future in‐depth exploration. These findings suggest that BS in Chinese patients was followed by rapid BP reductions, with lower BP observed among the smaller subsets assessed longer term, including those without severe obesity. Trial Registration : NCT07183137.