[Clinical portrait and features of antihypertensive therapy in comorbid patients with arterial hypertension and chronic obstructive pulmonary disease according to the national hypertension registry].

Abstract

Background: Cardiovascular diseases (CVD) and chronic obstructive pulmonary disease (COPD) are the two leading causes of death in the world. Studies show a close mutually aggravating relationship between arterial hypertension (AH) and COPD. Antihypertensive therapy in patients with AH and COPD has a number of features, aiming to reduce the risk of developing cardiovascular complications and mortality from CVD without worsening lung function.

Aim: To analyze the data of patients with AH and COPD included in the national registry to determine the burden of CVD risk factors, concomitant cardiovascular, cerebrovascular diseases and chronic kidney disease, obesity, diabetes mellitus, gout and characteristics of antihypertensive therapy.

Materials and methods: A comparative analysis of patients of the hypertension registry (conducted in outpatient clinics) was performed depending on the presence (n=3323) or absence (n=54073) of chronic obstructive pulmonary disease. Statistical analysis of the obtained data were performed using the R 4.3.3 statistical computing environment (R Foundation for Statistical Computing, Vienna, Austria).

Results: The prevalence of COPD in patients with hypertension was 5.8% (3323 cases). The presence of COPD in patients with hypertension, regardless of gender and age, was statistically significantly associated with higher odds of having coronary artery disease [odds ratio (OR) 2.21, 95% confidence interval (CI) 2.06-2.38; p<0.001], a history of myocardial infarction (OR 1.73, 95% CI 1.59-1.87; p<0.001), chronic heart failure (OR 1.95, 95% CI 1.82-2.1; p<0.001), a history of acute cerebrovascular accident (OR 1.25, 95% CI 1.07-1.46; p=0.004), transient ischemic attack (OR 2.9, 95% CI 2.31-3.59; p<0.001), atrial fibrillation (OR 1.68, 95% CI 1.45-1.93; p<0.001). Patients with hypertension and COPD more often received drugs from the group of angiotensin-II receptor antagonists than patients with hypertension without COPD (22.7% vs 17.7%). The prescription of drugs from the group of beta-blockers in patients with hypertension and COPD was lower by 4%. Cardiovascular risk factors, comorbidities such as diabetes mellitus, gout, obstructive sleep apnea in patients with hypertension and COPD are more common.

Conclusion: Patients with COPD and hypertension have a higher incidence of risk factors, CVD and comorbid pathologies. They require closer attention during examination and during the selection of antihypertensive therapy. In patients with hypertension and COPD, angiotensin-converting-enzyme inhibitors and beta-blockers are prescribed less frequently than in patients with hypertension without COPD due to possible side effects and contraindications.