PS-P15-4: THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OBESE HYPERTENSIVE PATIENTS: A STEP FORWARD IN DETERMINATION OF OPTIMAL TREATMENT

Abstract

Introduction: Obesity is a global problem. Morbid obesity (MO) represents a population with a body-mass index (BMI) of more than 40 kg/m2 eligible for surgical treatment (bariatric surgery). During the preoperative evaluation program, every patient must have a cardiopulmonary exercise test (CPET) for cardiopulmonary risk assessment. Also, in the morbid obese population, arterial hypertension (AH) is the most common comorbidity. Objectives: We aimed to compare the results of CPET in obese patients with and without AH treatment. Methods: We investigated 84 patients (40 males, age 40.50 ± 10.38) scheduled for surgical treatment of morbid obesity. Patients were divided into two groups according to the presence of AH, adjusted for sex and age. All patients underwent CPET for the preoperative risk assessment and determination of cardiopulmonary function. Result: The mean BMI was 45.37 ± 9.75 kg/m2. There was a significant difference in resting sistolic and diastolic blood pressure between the 2 groups (AH group, sistolic 144.33 ± 13–05 vs. 133 ± 11.26 mmHg, p = 0.001, diastolic AH group, 88.0 ± 7.36 mmHg vs. 84.10 ± 6.36 mmHg, respectively, p = 0.039) as well as at maximal effort (AH group, sistolic 182.13 ± 18.72 mmHg vs. 170.00 ± 13.00 mmHg p = 0.004; diastolic 101.67 ± 9.13 mmHg vs. 96.14 ± 9.16 mmHg, p = 0.018). There was no difference in peak oxygen consumption in AH patients compared to patients without AH (peakVO2 25.542.07 ml/kg/min vs. 26.78 ± 2.92 ml/kg/min, p = 0,147), and for VO2 at anaerobic threshold (VO2AT 14.153.11 ml/kg/min vs. 14.29 ± 3.62 ml/kg/min, P = 0–859). There was a significant difference in ventilatory response among those two groups of patients. Minute ventilation/carbon dioxide production (VE/VCO2) slope among the AH group was 24.89 ± 3.29, vs. 27.22 ± 3.97, p = 0.013, possibly due to demarcation of left ventricular diastolic dysfunction among the hypertensive group during exercise. Conclusions: CPET showed significant ventilatory impairment in MO patients with AH. Thus, individualized antihypertensive therapy should be the focus of preoperative programs for morbidly obese patients with AH.