Bariatric Surgery for High Blood Pressure

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What is High Blood Pressure (Hypertension)?

Blood pressure refers to the pressure of the blood against the inner walls of the arteries as the heart pumps. When that pressure is consistently high, extra strain is put on your heart and blood vessels, over time leading to serious conditions such as heart and kidney disease, stroke, diabetes, high cholesterol, sleep apnea, and risk for premature death.

What Causes High Blood Pressure?
If you have high blood pressure, the Centers for Disease Control (CDC) estimates that you are among the 75 million (one in three) adults in the United States who do.

Unfortunately, even at dangerously high levels, high blood pressure shows few signs or symptoms, earning it the name of “the silent killer.”

Though the signs of high blood pressure (shortness of breath, headaches, nosebleeds) are scarce and do not always point to the condition, multiple factors such as smoking, excessive alcohol use, poor diet, being overweight, and lack of exercise are clear as causes; of these, research has shown being overweight at the top of the list as a contributor to the condition.

Obesity and High Blood Pressure
When you carry excess weight, your heart must work harder. The harder your heart works, the higher your blood pressure rises.

When you lose weight, there is a meaningful drop in your blood pressure.

An estimated one-third of American adults are classified as obese, and for many, diet and exercise are not enough to achieve the weight loss to put their blood pressure in a safe range. For these people, bariatric surgery may be the answer.

What is Bariatric Surgery?
The purpose of bariatric surgery is to reduce the amount of your food intake by making you feel satisfied sooner, thus causing weight loss. Most bariatric surgeries are performed using laparoscopic (minimally invasive) techniques.

The most frequently used bariatric surgeries include:

  • Laparoscopic adjustable gastric band
  • Gastric sleeve surgery (sleeve gastrectomy)
  • Gastric bypass, most commonly used
  • Biliopancreatic diversion with duodenal switch, used less often.

Laparoscopic Adjustable Gastric Band
A ring with an inner inflatable band is placed around the top of the stomach leaving only a small sac for food.

Gastric Sleeve
Most of the stomach is removed, save for a curved section that is stapled shut.

Gastric Bypass
In gastric bypass surgery, the stomach is stapled, and a smaller sac for food is formed in its upper section. Next, the small intestine is cut, and the lower part attached directly to the newly created sac, detouring food away from most of the stomach and upper part of the small intestine, limiting the absorption of calories.

Duodenal Switch
The duodenal switch involves two separate surgeries. The first is much like gastric sleeve surgery, while the second redirects food so that it avoids the larger part of the small intestine. The more complex of the three other surgeries, the duodenal switch allows for greater weight loss, but is more likely to produce surgery-related difficulties.

Risks Associated with Bariatric Surgery
Gastric bypass and other weight-loss surgeries present possible health risks, as do all major surgeries; these include both long and short-term complications.

Among the risks associated with bariatric surgery are:

  • Infection
  • Adverse effects of anesthesia
  • Excessive bleeding
  • Blood clots
  • Breathing or lung problems
  • Gastrointestinal leakage
  • Death, though rare

Longer term risks and complications, which vary depending on the type of surgery, are also possible, including:

  • Obstruction of the bowel
  • Dumping syndrome (rapid gastric emptying)
  • Hernias
  • Gallstones
  • Hypoglycemia, (low blood sugar)
  • Malnutrition
  • Stomach puncture
  • Ulcers
  • Death, rare

When Considering Bariatric Surgery
Your doctor may evaluate whether you are a candidate for bariatric surgery based on your weight and blood pressure. Discuss the risks and benefits, along with your expectations regarding your outcome with your physician. Your current health will influence the success of the procedure and your recovery.

American Heart Association’s Blood Pressure Ranges

  • Normal: less than 120/80 mm Hg*
  • Prehypertension (early stage high blood pressure): 120 – 139/80–89 mm Hg
  • Hypertension Stage 1: 140 – 159/90–99 mm Hg
  • Hypertension Stage 2: 160/100 mm Hg
  • Hypertensive crisis: 180/110 mm Hg

*Upper number (systolic): Amount of pressure blood is putting against artery walls as heart beats
Lower number (diastolic): Amount of pressure blood is putting against artery walls between heart beats

Bariatric Surgeons

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