Background

Several insurance policies require the presence of hypertension, defined as blood pressure > 140 mmHg systolic (SBP), or 90 mmHg diastolic (DBP), despite concurrent use of >1 anti-hypertensive agents for patients with a BMI <40 kg/m2 to qualify for bariatric surgery (BS). No peer reviewed literature to support or refute such requirements exists.

Methods

A total of 461 patients who underwent BS were included. Systolic (SBP) and diastolic (DBP) blood pressure BP (in mmHg) was assessed by an automated manometer at each office visit until 3 years postoperatively and recorded in a prospectively maintained database.

Results

Thirty-three (7.15%) patients with BMI <40 Kg/m2, treated by 1, 2 or three anti-hypertensive medications and BP below 140/90, would have been denied BS under such policies. Number of anti-hypertensive medications had no impact on SBP/DBP control preoperatively. Patients being treated preoperatively with < 3 anti-hypertensive medications had a significantly higher % hypertension resolution at 1 (one-med: 66.2%, two-med: 50.9% vs. three-med: 12.5%, p<.0001), 2 (one-med: 63.9%, two-med: 52.8% vs. three-med: 15.4%, p=.0068) and 3 (one-med: 76.9%, two-med: 52.9% vs. three-med: 20%, p=.005) years postoperatively. Multivariate regression demonstrated a significant linear correlation between the number of preoperative anti-hypertensive medications and 1-year postoperative SBP, adjusting for BMI and age (p<.0001).

Conclusions

The earlier BS intervention takes place, related to the preoperative severity of hypertension, the more likely it will resolve postoperatively. Restricting access to BS because a patient has hypertension on <3 anti-hypertensive medications is not supported by our data and is harmful.