The effect of arterial hypertension on the functional capacity of morbidly obese diabetics

Introduction Morbid obesity represents a major health problem, in particular, associated with type 2 diabetes mellitus (DMT2). It is a significant risk factor for adverse cardiovascular events, especially for surgical procedures. Bariatric surgery is the ultimate treatment for weight reduction, but at the same time, as a major abdominal surgery, it has a higher risk. The cardiopulmonary exercise test (CPET) has been included in the preoperative assessment to evaluate the functional status and eligibility for surgical treatment, also examining the effect of comorbidities like hypertension (HTN). Purpose To evaluate the effect of HTN associated with DMT2 on the functional capacity of morbidly obese patients scheduled for bariatric surgery. Methods We assessed 87 morbidly obese patients with T2DM (mean age 44.33±9.38, 32 males) during preoperative evaluation for bariatric surgery. All patients underwent multidisciplinary clinical examinations, laboratory analysis, and echocardiography. Also, we evaluated the function of the cardiovascular, pulmonary, and circulatory systems by CPET (Treadmill, maximal Bruce protocol). We assessed the effects of arterial HTN and its effects on glycemic control and CPET parameters. Result The mean BMI of the morbid obese diabetics was 44.48±7.09 kg/m2. There was a significantly higher BMI in female vs. male patients (62.77±4.05 kg/m2 vs. 57.56±13,23 kg/m2 p=0,001). The mean glucose level was 7.18±2.54 mmol/L, whereas the mean glycosylated hemoglobin (HbA1c) was 7.21±1.55 % without differences regarding gender. All echocardiographic parameters were within normal limits, with the mean global systolic function of the left ventricle at 60.34±9.76 %. There were 55 patients with arterial HTN, and they had significantly lower peak oxygen consumption (peakVO2) in comparison to normotensive patients (17.62 ± 4.16 vs. 18.23±4.16 ml/kg/min, CI 16.69-18.53, p=0.001). Furthermore, patients with HTN had significantly lower VO2 at the ventilatory anaerobic threshold (VAT/VO2) compared to normotensive, 15.20±3.15 vs. 15.35±4.31 ml/kg/min. There was no difference in the ventilatory parameters in patients with or without HTN. Conclusions The presence of HTN in morbidly obese individuals with T2DM has an additional effect on reducing functional capacity, which can increase the risk for bariatric surgery. Therefore, evaluating the risk, CPET points to the need for optimal medical therapy and pressure regulation, among other measures, for improving the state of fitness.