GATEWAY Trial results show Patients Achieved Sustained Remission of Hypertension After Metabolic Surgery
Patients with mild to moderate obesity who underwent metabolic surgery kept their blood pressure under control and required fewer or no medications compared to patients on standard medical therapy, according to a new landmark study published online in Annals of Internal Medicine. GATEWAY,
a three-year study, is the first randomized clinical trial to compare the effectiveness of surgery to medical treatment of hypertension. Early results from the GATEWAY study, first published in 2018 in the medical journal Circulation, showed similar results.
In the new three-year study, 35% of metabolic surgery patients achieved full remission of their hypertension without the need for continued medication, only 2% of patients on medical therapy ever did. Notably, nearly three-quarters (73%) of metabolic surgery patients were able to stop taking 30% or more of their antihypertensive medications and still maintain a blood pressure of less than 140/90 mm Hg, the study’s primary endpoint. Only 11% of those on standard medical therapy alone were able to do the same over the three-year follow-up period.
No patients in the medical therapy group achieved a blood pressure lower than 130/80 mm Hg, a target achieved by 31% of gastric bypass patients. In addition, patients on drug therapy experienced a modest weight gain compared to surgical patients who on average lost 27.8% of their total body weight.
The GATEWAY results showed that improvements and remission of high blood pressure in metabolic surgery patients are sustainable over a longer period of time while those on conventional medical treatment continue to face difficulties with both hypertension and obesity. The single center randomized study included 100 patients all of whom had obesity (BMI between 30.0 and 39.9 kg/m2) and were taking at least two blood pressure medications at maximum doses or more than two medications at moderate doses.
Nearly half the adults in the United States (108 million, or 45%) have hypertension and 42% have obesity, which are independent risk factors for heart disease and stroke, leading causes of death. When a patient has both conditions, the risk of cardiovascular mortality may nearly double. The Centers for Disease Control and Prevention (CDC) reports that only about 1 in 4 adults (24%) with high blood pressure have it under control.
Randomized clinical trials now show metabolic surgery is the most effective and durable treatment for the diseases of obesity and type 2 diabetes. GATEWAY adds to the body of high-level evidence that showing the benefits of surgery extend far beyond weight loss.
Metabolic surgery is today a safe, 45-minute procedure requiring 4-5 Band-aids, in the hands of Dr. Sasse. In 2019 US hospital data, the sleeve gastrectomy was safer than an appendectomy procedure. Let’s give our patients a second chance of overcoming obesity and type 2 diabetes.
