The current direction of development of the clinic of internal medicine and family medicine is the management of patients with comorbid conditions hypertension (AH) with chronic obstructive pulmonary disease (COPD). The first stage was a retrospective analysis, which included revision of 286 outpatient charts of patients with AH and comorbid COPD at the primary care level. The second stage – an open, clinical, controlled comprehensive clinical and instrumental study of patients with stage II AH and comorbid COPD in comparison with patients with stage II AH without COPD and COPD without AH, as well as with a control group. The third stage – open prospective controlled for 6 months complex drug treatment of patients with AH and comorbid COPD with division into two groups depending on the presence of remodeling left ventricle with preserved or mid-range ejection fraction (EF). Cardiovascular risk (CVR) on the SCORE scale was determined only in 22.0% of cases. ECG was recorded in 70.3%. COPD was spirometrically confirmed in 34.3% patients. Among antihypertensive drugs were most often prescribed ACE inhibitors with diuretics (45.1%), but significantly less used ARBs and calcium antagonists (27.9 and 10.5%). Only 27.6% of patients received lipid-lowering drugs. Bronchodilation basic therapy, among patients with COPD confirmed spirometrically, included salbutamol in 66.3% of patients, ipratropium bromide with fenoterol in 33.7%, tiotropium bromide – 65.3%, salmeterol in combination with inhaled corticosteroid fluticasone – 46.9%.
In patients with hypertension and comorbid COPD, dominant direction of LV remodeling was concentric LV hypertrophy (LVH) (55.8%) and concentric remodeling (32.5%).
Based on the ROC analysis of SpO2 at the cut-off point ≤94.9% (sensitivity - 95.5%, specificity - 77.1%), prognostic effect of hypoxemia on LV systolic dysfunction was established.
In patients with AH and comorbid COPD, the daily blood pressure (BP) profile in the vast majority of cases (91.7%) corresponded to the phenotypes of non-dipper (54.2%) and night-peaker (37.5%). Relationship between the daily profile of blood pressure (BP) and concentric direction of LV remodeling was established, the predominance of sympathetic tone in comorbidity of AH and COPD (LF/HF ratio (2.01 (1.90; 2.31)) was revealed. An interdependence was established between autonomic dysfunction, daily BP profile, bronchial obstruction and cardiac remodeling phenotype. In the stratification of patients with AH and comorbid COPD on the SCORE scale there were no cases with low cardiovascular risk (CVR), more than 50.0% of patients responded with moderate CVR, more than a third – high, other – very high CVR. When comparing biological age was found that premature vascular aging was highest among patients with AH and comorbid COPD, and was different from chronological by 18.3 (12.6; 24.5) age. The duration of COPD correlated with CVR (rs=0.28;p<0.05), FEV1/FVC (rs=0.43;p<0.05), the duration of AH (rs=0.75; p<0.05) and age (rs=0.35;p<0.05), which indicates the effect of COPD on CVR. Assessment of quality of life (QoL) showed that patients with non-dipper and night-peaker profiles were dominated by social maladaptation (rs=0.32;p<0.05), and the SGRQ questionnaire significantly increased the "activity" in patients with grades 2 and 3 AH and comorbid COPD compared with grade 1, which indicates the role of AH in the daily activities of patients with comorbid COPD. Personalized approach to the treatment of patients with stage II AH and comorbid COPD has been developed, which consists in the use for 6 months of combination of valsartan with amlodipine in diastolic LV dysfunction (EF ≥50%) or candesartan with nebivolol in asymptomatic dysfunction with mid-range EF 49-45%, which provided a long-lasting antihypertensive effect, moderate regression of LV hypertrophy (by 14.2 and 17.1 g/m², respectively), reduction of diastolic dysfunction by E/A (by 12.5 and 28.6%) and an increase in EF by 6,6% with mid-range EF without adverse effects on the course of COPD. The use of a dual combination of long-acting inhaled bronchodilators in a single inhaler of umeclidinium bromide with vilanterol as a basic therapy for COPD did not adversely affect the structural and functional state of the LV and significantly improved QoL and adherence to treatment. An integrated cardiorespiratory test has been developed to evaluate the effectiveness of treatment of patients with AH and comorbid COPD, based on the main factors limiting exercise tolerance: 6-minute walk test (6-MWT), the level of blood desaturation with oxygen (∆SpO2); insufficient increase in systolic BP; double product; chronotropic and inotropic reserve against the background of impaired bronchial obstruction. The correlation between 6-MWT and ΔSpO2 (rs=-0.45;p<0.05) and FEV1 (rs=0.67;p<0.05) proves the leading role of hypoxemia and bronchial obstruction in limiting the physical activity of patients with AH and comorbid COPD.
