Pathophysiological Bases of Arterial Hypertension in Serious Obesity Studies on Obese Patients Treated with Biliopancreatic Diversion

According to a great number of wide epidemiological studies, obesity increases the risk for hypertension. In our study, arterial pressure values have been pointed out in 10 patients (average age 34.4 years),who were morbidly obese (Body Mass Index over 40) and had already undergone a biliopancreatic diversion.All patients showed diastolic hypertension (values over 90 mmHg),whereas systolic pressure was high only in 2 patients (values over 160 mmHg).As a result of the biliopancreatic diversion, as expected,we have registered a significant reduction in weight during the following 4 months.An average 26,48% reduction of body weight (19,29% - 47,37%) was shown,with a reduction from 49.33 to 36.17 of mean Body Mass Index. Postoperatively, both systolic and diastolic blood pressure became normal again in all patients, although someone was still morbidly obese; no patient required antihypertensive drugs.This aggressive surgical operation, nevertheless, has fallen into disuse. Today bariatric surgery, prescribed only to seriously obese patients and in case of failure of other therapies, consists of reversible and more less disabling operations.The results are similar, when a careful selection of patients is preventively carried out.Mechanisms linking obesity to arterial hypertension are still unclear (hypervolemia; hyperactivity of orthosympathetic system; reduction of level of natriuretic atrial factor).