Evaluation of Cardiovascular Risk and Blood Pressure Parameters in Patients with Bronchial Asthma and Co-Existent Chronic Obstructive Pulmonary Disease

Ksenia Nazarenko

Abstract


The combination of arterial hypertension, asthma and COPD has a significant prevalence in clinical practice. The presence of hypertension contributes to the growth of severity of asthma-COPD overlap (ACO), the worst prognosis and a high risk of cardiovascular complications. Coexistence of diseases changes the course of each of them, contributes to the early formation of complications and creates certain difficulties for therapy.

The aim of work was to investigate the factors of cardiovascular risk, as well as the arterial pressure indicators of patients with ACO.

Patients. 140 patients with ACO with an average forced expiratory volume for the first second (FEV1) (59.0 ± 1.4)% and the ratio of forced expiratory volume in the first second to the forced vital capacity of the lungs (FEV1 / FVC) (53.6 ± 0.8)%. Methods. All the patients underwent measurement of body weight and height, measurement of office systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour ambulatory blood pressure monitoring (ABPM), biochemical blood test, coagulogram, assessment of total cardiovascular risk on a SCORE scale, the risk of cardiovascular complications on QRISK2 scale, the risk of developing diabetes mellitus (DM) on QDiabetes scale.

Results. Patients with ACO had some pathological changes in blood pressure. Also, these patients had a significant overload with arterial pressure. Also, in these patients, the diurnal index (DI) of SBP and DI DBP were significantly reduced relatively to normal values.

Patients with ACO predominantly belonged to the group of moderate risk of fatal cardiovascular events in 10 years (3.83%). The QRISK2 is quite significant, and is more than 15%. There is also a fairly significant risk of developing DM (more than 13%).

A higher concentration of inflammational markers was revealed in ACO patients  with more severe bronchial obstruction (significant increase in C-reactive protein and fibrinogen with increased bronchial obstruction).

ACO patients from subgroups GOLD 1 and GOLD 2 predominantly belonged to the group of moderate risk, and patients from the GOLD 3.4 subgroup predominantly had a high risk of developing fatal cardiovascular events over the next 10 years (according to the SCORE scale). The QRISK2 scale risk was also moderate in the first two subgroups and high in patients with severe bronchial obstruction (GOLD 3,4).

Conclusions. In patients with a combination of asthma and COPD, significant cardiovascular comorbid pathology, a high prevalence of arterial hypertension, a high degree of overload with arterial pressure were found. Significant violations of the variability of blood pressure were also revealed. In this category of patients, a moderate risk of developing fatal cardiovascular events, as well as the development of diabetes within the next 10 years is also determined. Even more significant violations of blood pressure and high rates of cardiovascular risk were detected in patients with a combined pathology with a higher degree of bronchial obstruction.


Keywords


asthma; COPD; hypertension; cardiovascular risk

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DOI: http://dx.doi.org/10.21802/gmj.2017.3.1

Copyright (c) 2017 Ksenia Nazarenko

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