Abstract
Essential hypertension and chronic obstructive pulmonary disease often coexist in the same patient. The aim of this study was to evaluate whether the addition of chronic obstructive pulmonary disease modifies the risk of cardiovascular events in hypertensives. We enrolled 1728 hypertensives. Study outcomes included fatal and non-fatal cardiovascular stroke and myocardial infarction, and cardiovascular death. During a mean follow-up of 57 months there were 205 major adverse cardiovascular events (2.47 per 100 pts/yr): cardiac (n117; 1.41 per 100 pts/yr) and cerebrovascular (n = 77; 0.93 per 100 pts/yr). In hypertensives with chronic obstructive pulmonary disease we observed a greater number of cardiovascular events than in hypertensives without respiratory disease (133 [5.55 per 100 pts/yr) vs 72 [1.22 per 100 pts/yr], respectively. The addition of chronic obstructive pulmonary disease to hypertension increased the incidence of total and non-fatal stroke of more than nine- (2.42 vs 0.32 per 100 pts/yr) and 11-fold (2.09 vs 0.22 per 100 pts/yr), respectively. The same trend was observed for total (2.88 vs 0.81 per 100 pts/yr) and non-fatal (2.67 vs 0.79 per 100 pts/y) myocardial infarction. The presence of chronic obstructive pulmonary disease in hypertensives significantly increases the risk of stroke, myocardial infarction and major adverse cardiovascular events.
Introduction
Life expectancy has improved dramatically over recent decades1. The ageing of populations and the increase of non-communicable diseases lead to a rapid rise of the number of people with multiple health conditions2. Of interest, this multimorbidity, defined as the coexistence of two or more chronic conditions in the same individual, has a relevant impact on clinical practice, disease prognosis and national healthcare systems costs3.
Essential hypertension (HT) and chronic obstructive pulmonary disease (COPD) are two of the most prevalent chronic diseases worldwide and are responsible for more than 8 and 3 million deaths per year respectively4,5, representing two of the leading causes of death in industrialized Countries. Of interest, both conditions are often present in the same patient, probably because they share some common risk factors6, contributing to the increase of the cardiovascular (CV) risk burden in a multiplicative manner7,8,9,10.
Even if it is well known that HT represents the most frequent comorbidity in COPD, occurring in more than 50% of patients11, few data exist on the prevalence of respiratory disease in hypertensive patients and on its role in the appearance of clinical outcomes5, probably because COPD still remains an underdiagnosed chronic disease despite its great impact on CV morbidity and mortality. Consequently, the prognostic significance of COPD in hypertensive patients, especially with regard to stroke occurrence, needs to be further elucidated. Thus, the aim of the present study was to evaluate the role of COPD in the appearance of fatal and non-fatal stroke and myocardial infarction (MI), and CV death, in a large and well-characterized cohort of hypertensive patients.
Results
Study population
In Table 1 we reported the baseline demographic, clinical and biochemical characteristics of the whole study population and of the two groups, divided according to the presence/absence of COPD, separately. The mean age of the whole study population was 61 ± 12 years; there were 1046 males (60.5%) and 1161 (67.2%) habitual smokers; systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were 143 ± 17 and 89 ± 11 mmHg, respectively. Patients with both HT and COPD, representing 30.3% of the whole study population, were older with a higher prevalence of males and smokers. In addition, they had a higher body mass index (BMI), SBP, pulse pressure (PP) and hs-CRP, and lower values of estimated glomerular filtration rate (e-GFR) and HDL cholesterol. No significant differences were observed in anti-hypertensive treatment between groups, except for a reduced use of β-blockers in HT + COPD patients (Table 2), as expected. Similarly, no significant differences between groups (68 vs 67% in the HT and HT + COPD patients, respectively) were observed in the percentage of patients reaching blood pressure (BP) target.