(Neither for nor against | Reviewed, New-added) Discussion The Work Group also looked at the evidence for offering bariatric surgery for the treatment of HTN for patients with obesity and HTN. There was insufficient evidence in the studies reviewed by the Work Group to recommend for or against offering bariatric surgery for the treatment of HTN. The evidence for this recommendation was based on one SR [105] and one RCT.[104] In the RCT, by Schiavon et al. (2018), patients with a BMI of 30 to 39.9 kg/m2 were followed for 12 months after surgical intervention and demonstrated a greater reduction in anti-hypertensive medication usage as compared to patients treated with medications (from an average of three medications to zero to one). There were adverse events reported when patients were medically or surgically treated.[104] Schiavon et al. (2018) reported no differences in reduction of SBP and DBP between medical or surgical treatment groups.[104] The SR by Yan et al. (2016) followed the patients receiving medical treatment or bariatric surgery for 12 to 60 months; the highest BMI was 43 kg/m2 .[105] Yan et al. (2016) found only a statistically significant decrease in SBP in the bariatric surgery treatment group.[105] The confidence of the quality of the evidence is very low, and benefits and harms were balanced. As this is a Reviewed, New-added, the Work Group systematically reviewed evidence related to this recommendation identified in the evidence review conducted as part of this guideline update.[104,105] The confidence in the quality of the evidence was very low. The benefit and harms of bariatric surgery are balanced. The potential for positive outcomes was balanced with the risk of adverse events from surgery. 