The midterm effects of bariatric surgery on patients with complications of obesity and hypertension were uncertain. This randomized clinical trial was aimed to determine the three-year effects of Roux-en-Y gastric bypass on blood pressure compared with medical therapy. This study was initiated by an investigator at Heart Hospital (HCor), São Paulo, Brazil. The study participants involved patients with hypertension receiving at least two medications at maximum doses or more than two medications at moderate doses and with a BMI between 30.0-39.9 kg/m2 were randomly assigned.

Among all patients, 88% from the RYGB group and 80% from the MT group completed follow-up. After three years, the RYGB group and the MT group achieved BP lower than 140/90 mm Hg and 130/80 mm Hg without medications. The total weight loss was 27.8% in the RYGB and −0.1% in the MT groups. In the RYGB group, thirteen patients developed vitamin B12 deficiency, and two patients required reoperation.

In conclusion, RYGB is an effective strategy for controlling midterm hypertension and obesity. Bariatric surgery is a viable strategy for lowering the number of antihypertensive drugs in patients with obesity and hypertension while maintaining well-controlled BP after three years. It may also be an attractive option for patients with obstinate hypertension or nonadherence to MT, but its related consequences are significant concerns.