Prospective follow-up of hypertensive patients with concomitant chronic respiratory diseases in routine practice. Part I. Characterization of adverse events

Abstract

The most common cardiovascular disease (CVD) and risk factor for the main causes of death is hypertension (HTN), the prevalence of which in Russia is 44%. The combination of HTN and chronic respiratory diseases (CRDs) can lead to mutual influence and worsen the prognosis.Aim. To study long-term outcomes in HTN patients with CRDs under outpatient monitoring in primary health care.Material and methods. This prospective observational study of hypertensive outpatients (n=156, age, 63,4±8,8 years, men, 27,6%) was carried out, of which 49 had asthma, 20 — chronic obstructive pulmonary disease (n=69; group with CRD). The composite primary endpoint included death, myocardial infarction, cerebral stroke, transient ischemic attack, arterial revascularization, angina pectoris, peripheral arterial disease (>50% stenosis), heart failure, atrial fibrillation, and ventricular premature beats >30 h. There were following secondary endpoints: hypertensive crisis, hospitalization, emergency call and temporary disability due to cardiovascular diseases, asthma, chronic obstructive pulmonary disease, pneumonia, chronic respiratory failure. In addition, the following tertiary endpoints were analyzed: increased blood pressure (BP) without a hypertensive crisis, which required correction of HTN therapy, deterioration in CRD course (an increase in the ACQ-5 or CAT total score without exacerbation), acute bronchitis, other acute diseases and exacerbations of chronic ones, which required hospitalizations, new clinically significant chronic diseases not included in the primary and secondary endpoints.Results. The follow-up period was 29±8 months. The groups did not differ in relation to prevalence of primary endpoints. The frequency of secondary and tertiary endpoints was higher in the CRD group due to "respiratory" events and episodes of BP destabilization requiring correction of HTN therapy (p<0,01). In HTN patients with CRDs, cumulative survival was lower, and the cumulative risk of adverse events was higher.Conclusion. Larger studies are needed in this area, as well as an analysis of the factors associated with adverse outcomes in hypertensive patients, including BP characteristics and accounting for CRDs, in order to improve preventive approaches.

Keywords

• hypertension
• blood pressure
• asthma
• chronic obstructive pulmonary disease
• chronic respiratory diseases
• outcomes
• end points
• prospective observation
• comorbidity