Артериальная гипертония и хроническая обструктивная болезнь легких: клиническая характеристика и эффективность лечения (по данным Национального регистра артериальной гипертонии)
Артериальная гипертония и хроническая обструктивная болезнь легких: клиническая характеристика и эффективность лечения (по данным Национального регистра артериальной гипертонии)
Чазова И.Е., Лазарева Н.В., Ощепкова Е.В. Артериальная гипертония и хроническая обструктивная болезнь легких: клиническая характеристика и эффективность лечения (по данным Национального регистра артериальной гипертонии). Терапевтический архив. 2019; 91 (3): #–10. DOI: 10.26442/00403660.2019.03.000110
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Chazova I.E., Lazareva N.V., Oshchepkova E.V. Arterial hypertension and chronic obstructive pulmonary disease: clinical characteristics and treatment efficasy (according to the national register of arterial hypertension). Therapeutic Archive. 2019; 91 (3): #–10. DOI: 10.26442/00403660.2019.03.000110
Артериальная гипертония и хроническая обструктивная болезнь легких: клиническая характеристика и эффективность лечения (по данным Национального регистра артериальной гипертонии)
Чазова И.Е., Лазарева Н.В., Ощепкова Е.В. Артериальная гипертония и хроническая обструктивная болезнь легких: клиническая характеристика и эффективность лечения (по данным Национального регистра артериальной гипертонии). Терапевтический архив. 2019; 91 (3): #–10. DOI: 10.26442/00403660.2019.03.000110
________________________________________________
Chazova I.E., Lazareva N.V., Oshchepkova E.V. Arterial hypertension and chronic obstructive pulmonary disease: clinical characteristics and treatment efficasy (according to the national register of arterial hypertension). Therapeutic Archive. 2019; 91 (3): #–10. DOI: 10.26442/00403660.2019.03.000110
Артериальная гипертония (АГ) является одним из ведущих факторов, определяющих высокую смертность населения во многих странах мира, включая Россию. Естественное постарение населения начала ХХ века ведет за собой медицинские и социально-экономические проблемы, одной из которых является частая коморбидность. Распространенность хронической обструктивной болезни легких (ХОБЛ) среди населения, особенно у городских жителей и мужчин, достаточно велика. АГ и ХОБЛ – одно из частых коморбидных состояний, сочетание этих заболеваний определяет высокий уровень инвалидности и неблагоприятный прогноз. Целью данного исследования явилось изучение демографической, клинической характеристики и эффективности лечения больных АГ с ХОБЛ на основе Национального регистра артериальной гипертонии. Материалы и методы. Среди анализируемой выборки, состоявшей из 32 571 больного АГ, наблюдавшегося в первичном звене здравоохранения, среднего возраста 64±7 лет, из которых 64% составляли женщины, ХОБЛ выявлена у 5,4% больных АГ. Проводился анализ частоты сердечно-сосудистых и цереброваскулярных заболеваний и эффективности лечения у больных АГ с ХОБЛ. Результаты. У больных АГ с ХОБЛ, по данным Национального регистра артериальной гипертонии, достоверно чаще диагностированы сердечно-сосудистые [ишемическая болезнь сердца, Q инфаркт миокарда, хроническая сердечная недостаточность (ХСН), атеросклероз периферических артерий] и цереброваскулярные заболевания (инсульт/транзиторная ишемическая атака). Заключение. Независимым наиболее сильным фактором, определяющим риск развития сердечно-сосудистых заболеваний у этих больных, является мужской пол и возрастной фактор. ХОБЛ значительно повышает риск развития ХСН. Проведенный анализ показал, что лечение, назначенное больным АГ с ХОБЛ, соответствует современным рекомендациям.
Arterial hypertension (AH) is one of the major factors, causing high level of population mortality in many countries, including Russia. Natural aging of population in the beginning of 20th century leads to medical and social issues; and frequent comorbidity is one of them. The occurrences of chronic obstructive pulmonary disease (COPD) are rather often among the population, especially among city dwellers and males. AH and COPD are frequent comorbid conditions; combination of these diseases contributes to high level of disability and poor prognosis. The objective of the research is studying of demographic and clinical profile as well as treatment effectiveness of patients with AH and COPD based on National Register of Arterial Hypertension. Methods and materials. Among the analyzed selection, consisted of 32 571 patients with AH, who were followed up in the primary medical care, at the average age of 64±7 years old (there were 64% women of them), 5.4% patients with AH had COPD. The analysis of cardiovascular and cerebrovascular diseases frequency as well as treatment effectiveness was made. Results. According to National Register of Arterial Hypertension, cardiovascular [coronary heart disease, Q myocardial infarction, chronic heart failure (CHF), peripheral artery atherosclerosis] and cerebrovascular (stroke/transitory ischemic attack) diseases are accurately more often diagnosed at patients with AH and COPD. Conclusion. Male sex and age are the strongest independent factor, contributing into the risk of development of cardiovascular diseases at these patients. COPD considerably increases the risk of CHF development. The conducted analysis has shown that treatment, prescribed to patients with AH and COPD meets modern recommendations.
Keywords: arterial hypertension, national register of arterial hypertension, diagnosis, treatment effectiveness.
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1. Chazova IE, Zhernakova IuV, Oshchepkova EV i dr. Rasprostranennost' FR serdechno-sosudistykhzabolevanii v rossiiskoi populiatsii bol'nykh arterial'noi gipertoniei. Kardiologiia. 2014;10:4-12 (In Russ.) https://doi.org/10.26442/terarkh20189098-14
2. Chazova IE, Oshchepkova EV. Itogi realizatsii Federal'noi tselevoi programmy po profilaktike i lecheniiu arterial'noi gipertenzii v Rossii v 2002–2012 gg. Vestn. Rossiiskoi Akademii meditsinskikh nauk. 2013;2:4-11 (In Russ.)
3. Heart disease and Stroke statistics – 2016 update: a report from the American Heart Association. Circulation. 2016;133.
4. Wolf-Maier K, Cooper RS, Banegas JR, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada and the United States. JAMA. 2003;289:2363-9. doi:10.1001/jama.289.18.2363
5. Klinicheskie rekomendatsii “Diagnostika i lechenie arterial'noi gipertonii”. Rabochaia gruppa po podgotovke teksta: Chazova IE, Oshchepkova EV, Zhernakova IuV. Kardiologicheskii vestn. 2015;1:5-30 (In Russ.)
6. 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;31(7):1281-357. doi: 10.1097/01.hjh. 0000431740.32696.cc.
7. Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, Nair H, Gasevic D, Sridhar D, Campbell H, Chan KY, Sheikh A, Rudan I. Global Health Epidemiology Reference Group (GHERG). Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health. 2015;5(2):020415. doi: 10.7189/ jogh.05-020415.
8. Haeusler KG, Herm J, Konieczny M. Impact of chronic inflammatory airway disease on stroke severity and longterm survival after ischemic stroke – a retrospective analysis. BMC Neurol. 2015;15:164. doi: 10.1186/s12883-015-0414-1
9. Hardie JA, Vollmer WM, Buist AS, Bakke P, Morkve O. Respiratory symptoms and obstructive pulmonary disease in a population aged over 70 years. Respir Med. 2005;99:186-95. https://doi.org/10.1016/ j.rmed.2004.06.006
10. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28:523-32. doi:10.1183/09031936.06.00124605
11. Zeng LH, Hu YX, Liu L, Zhang M, Cui H. Impact of beta2-agonists, betablockers, and their combination on cardiac function in elderly male patients with chronic obstructive pulmonary disease. Clin Interv Aging. 2013;8:1157-65. doi: 10.2147/CIA.S49644. Epub 2013 Sep 10
12. Zadionchenko VS, Volkova NV, Kopalova SM. System and pulmonary hypertension under the conditions of chronic non-specific pulmonary diseases. Russian Medical Magazine. 1996;4(12):28-37 (In Russ.)
13. Zadionchenko VS, Adasheva TV, Shilova EV and others. Clinic and Functional Characteristics of Arterial Hypertension at Patients with Chronic Obstructive Pulmonary Diseases. Russian Medical Magazine. 2003;11(9):535-8 (In Russ.)
14. Kubishkin VF, Soldatchenko SS, Konovalov VI. Characteristics of Clinical Course of Chronic Obstructive Pulmonary Diseases, Combining with System Arterial Hypertension. Therapeutic Archive. 1985;57(2):114-6 (In Russ.)
15. Dart RA, Gollub S, Lazar J, et al. Treatment of systemic hypertension in patients with pulmonary disease. Chest. 2003;123:222-43.
16. Antonelli Incalzi R, Fuso L, De Rosa M, et al. Comorbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J. 1997;10:2794-800.
17. Rabahi MF, Pereira SA, Silva Júnior JL, de Rezende AP, Castro da Costa A, de Sousa Corrêa K, et al. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms. Int J Chron Obstruct Pulmon Dis. 2015;10:1525-9. doi: 10.2147/COPD.S85588
18. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532-55. doi:10.1164/rccm.200703-456SO
19. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-82. doi:10.1164/rccm.201701-0218PP
20. Nicola Di Daniele. Therapeutic approaches of uncomplicated arterial hypertension in patients with COPD. J Pulmonary Pharmacology & Therapeutics. 2015;35:1-7.
21. Goncalves J, Sanchez R, et al. Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease in the Canary Islands (CCECAN study). J Clin Investig Arteriosclerosis. 2017;29(4):149-56.
22. Чазова И.Е. Артериальная гипертония и хроническая обструктивная болезнь легких. Consilium medicum. 2006;8(5) [Chazova IE. Arterial Hypertension and Chronic Obstructive Pulmonary Disease. Consilium medicum. 2006;8(5) (In Russ.)].
23. Chazova IE, Chuchalin AG, Zykov KA, Ratova LG. Diagnostics and treatment of patients with an arterial hypertonia and a chronic obstructive pulmonary disease (References of the Russian medical society on an arterial hypertonia and the Russian respiratory society). Systemic Hypertensions. 2013;1:5-34 (In Russ.)
24. Oshchepkova EV, Lazareva NV, Chazova IE. Quality assessment of examination of patients with arterial hypertension in primary health care (according to the Russian arterial hypertension register data). Systemic Hypertension. 2017;14(2):29-34 (In Russ.) https://doi.org/10.26442/
25. Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonarydisease as an independent risk factor for cardiovascular morbidity. Int J Chronic Obstr Pulmon Dis. 2009;4:337-49.
26. Feary JR, Rodrigues LC, Smith CJ, Hubbard RB, Gibson JE. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax. 2010;65:956-62. doi: 10.1136/thx.2009.128082
27. de Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-GonzalezMoro JM, Frances JF, Lozano PV, Bellón-Cano JM, CONSISTE study group. Chronic obstructive pulmonary disease as a cardiovascular risk factor. Results of a case-control study (CONSISTE study). Int J Chronic Obstr Pulmon Dis. 2012;7:679-86. doi:10.2147/COPD.S36222
28. Dal Negro RW, Bonadiman L, Turco P. Prevalence of different comorbidities in COPD patients by gender and GOLD stage. Multidiscip Respir Med. 2015;10:24. doi: 10.1186/s40248-015-0023-2
29. Lunde H, Hedner T, Samuelsson O et al. Dyspnoea, asthma, and bronchospasm in relation to treatment with angiotensin converting enzyme inhibitors. BMJ. 1994;308:18-21.
30. Benz J, Oshrain C, Henry D, et al. Valsartan, a new angiotensin II receptor antagonist: a double-blind study comparing the incidenceof cough with lisinopril and hydrochlorothiazide. J Clin Pharmacol. 1997;37:101-7.
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Авторы
И.Е. Чазова, Н.В. Лазарева, Е.В. Ощепкова
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
________________________________________________
I.E. Chazova, N.V. Lazareva, E.V. Oshchepkova
National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia