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Prevalence and Characteristics of Blood Pressure Phenotypes in Patients with Hypertension and Chronic Respiratory Diseases (Study of Ambulatory Practice Data of a Cardiologist)

https://doi.org/10.20996/1819-6446-2020-08-20

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Abstract

Diagnosis of the blood pressure (BP) phenotype is the most important indication for its ambulatory measurement because BP phenotype is associated with cardiovascular complications and death. The study of BP phenotypes is important for patients with hypertension (HT) and comorbidity, including asthma and chronic obstructive pulmonary disease (COPD). The combination of HT with these lower airway diseases (LAD) leads to the mutual influence of pathologies creates difficulties in the drugs choice and may affect BP phenotype in HT patients.

Aim. To compare in the prospective investigation various characteristics of BP phenotype in HT patients considering LAD (asthma or COPD).

Material and methods. The prospective cohort study of ambulatory patients with HT (n=156) was carried out. The part of these patients had asthma or COPD (n=69). The clinical measurements and 24-hour BP monitoring, spirometry, clinical and biochemical blood tests, standard examination were performed, initially and after 12 months. BP phenotype were determined by the ratio of clinical BP and ambulatory BP considering their threshold values. Standard statistical methods and multivariate analysis were used.

Results. Patients with LAD had 2 times more often prognostically unfavorable phenotypes: ineffective antihypertensive therapy (AHT) 37.3% vs 15.7% and masked AHT inefficiency 7.5% vs 4.5%; white coat HT on treatment (WCH) and effective AHT were less common(29.9% vs 42.7%; 25.5% vs 37.1%, respectively, p 148 mm Hg (b=2.733, p=0.040), LAD (b=1.015, p=0.011), serum total cholesterol (b=0.350, p=0.043), degree of nighttime diastolic BP decrease (for 13.1-18.0% b=-2.130, p=0.004; for 18.1-24.0% b=-2.509, p=0.001). The factors associated with masked AHT inefficiency in comparison to effective AHT were heart rate in orthostasis >87 beats/min(b=3,512, p=0.006) and SBP in orthostasis 141-148 mm Hg (b=3.405, p=0.004).

Conclusion. The prevalence of prognostically unfavorable BP phenotypes (ineffective AHT and masked AHT inefficiency) is two times higher in HT patients with LAD. The first is associated with LAD presence, sex, and serum cholesterol; both phenotypes interrelated with hemodynamic parameters including degree of nighttime diastolic BP decrease. We found no association between AHT and LAD therapy with the BP phenotypes in this study. However, larger works in this area are required, including analysis of outcomes in long-term prospective studies.

About the Authors

A. S. Kurekhyan
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Armine S. Kurekhyan – Researcher, Laboratory for Prevention of Chronic Respiratory Diseases

Petroverigsky per. 10, Moscow, 101990



M. I. Smirnova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Marina I. Smirnova – MD, PhD, Head of Laboratory for Prevention of Chronic Respiratory Diseases

Petroverigsky per. 10, Moscow, 101990



V. M. Gorbunov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Vladimir M. Gorbunov – MD, PhD, Professor, Head of Laboratory of Ambulatory Diagnostic Methods in the Prevention of Chronic Non-Communicable Diseases

Petroverigsky per. 10, Moscow, 101990



Ya. N. Koshelyaevskaya
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Yana N. Koshelyaevskaya – Programmer, Laboratory of Ambulatory Diagnostic Methods in the Prevention of Chronic Non-Communicable Diseases

Petroverigsky per. 10, Moscow, 101990



A. D. Deev
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Alexander D. Deev – PhD (in Physics and Mathematics), Leading Researcher, Department of Epidemiology of Chronic Noncommunicable Diseases

Petroverigsky per. 10, Moscow, 101990



M. M. Loukianov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Mikhail M. Loukianov – MD, PhD, Head of Department of Clinical Cardiology and Molecular Genetics

Petroverigsky per. 10, Moscow, 101990



References

1. Satoh M., Asayama K., Kikuya M., et al. Long-term stroke risk due to partial white-coat or masked hypertension based on home and ambulatory blood pressure measurements: the Ohasama study. Hypertension. 2016;67(1):48-55. DOI:10.1161/HYPERTENSIONAHA.115.06461.

2. Stergiou G.S., Asayama K., Thijs L., et al. Prognosis of White-Coat and Masked Hypertension International Database of Home Blood Pressure in Relation to Cardiovascular Outcome. Hypertension. 2014;63(4):675-82. DOI:10.1161/HYPERTENSIONAHA.113.02741.

3. Mancia G., Facchetti R., Bombelli M., et al. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47(5):846- 53. DOI:10.1161/01.HYP.0000215363.69793.bb.

4. Sega R., Trocino G., Lanzarotti A., et al. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: Data from the general population(Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation. 2001;104(12):1385-92. DOI:10.1161/hc3701.096100.

5. Bangash F., Agarwal R. Masked hypertension and white-coat hypertension in chronic kidney disease: a meta-analysis. Clinical Journal of the American Society of Nephrology. 2009;4(3):656-664. DOI:10.2215/CJN.05391008.

6. Drager L.F., Pedrosa R.P., Diniz P.M., et al. The effects of continuous positive airway pressure on prehypertension and masked hypertension in men with severe obstructive sleep apnea. Hypertension. 2011;57(3):549-55. DOI:10.1161/HYPERTENSIONAHA.110.165969.

7. Eguchi K., Ishikawa J., Hoshide S., et al. Masked hypertension in diabetes mellitus: a potential risk. The Journal of Clinical Hypertension. 2007;9(8):601-7. DOI:10.1111/j.1524-6175.2007.06610.x.

8. Kanno A., Metoki H., Kikuya M., et al. Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study. Hypertension Research. 2010;33(11):1192-8. DOI:10.1038/hr.2010.139.

9. Terawaki H., Metoki H., Nakayama M., et al. Masked hypertension determined by self-measured blood pressure at home and chronic kidney disease in the Japanese general population: the Ohasama study. Hypertension Research. 2008;31(12):2129-35. DOI:10.1291/hypres.31.2129.

10. Camargo C.A., Barr R.G., Chen R., Speizer F.E. Prospective study of inhaled corticosteroid use, cardiovascular mortality, and all-cause mortality in asthmatic women. CHEST Journal. 2008;134(3):546-51. DOI:10.1378/chest.07-3126.

11. The top 10 causes of death. WHO Fact sheet, 24 May 2018 [cited by Feb 01, 2020]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.

12. Clarenbach C.F., Kohler M. Is COPD a Cardiovascular Risk Factor? Praxis. 2011;100(2):85-90. DOI:10.1024/1661-8157/a000411.

13. Sidney S., Sorel M., Quesenberry C.P. Jr., et al. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest Journal. 2005;128(4):2068- 75. DOI:10.1378/chest.128.4.2068.

14. Rogoza A.N., Nikolskij V.P., Oshchepkova E.V., et al. Daily monitoring of blood pressure in hypertension. Methodical recommendations. Moscow: RKNPK MZ RF; 1997 (In Russ)

15. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-104. DOI:10.1093/eurheartj/ehy686.

16. Karpov Yu.A. New recommendations on arterial hypertension RSH/SCR 2010: questions of combination therapy. Russian Medical Journal. 2010;22:1290-7 (In Russ.)

17. Smirnova M.I., Gorbunov V.M., Kurekhyan A.S., et al. Different Types of Blood Pressure Variability in Hypertensive Patients with Chronic Lower Airway Diseases. Rational Pharmacotherapy in Cardiology. 2018;14(6):816-25 (In Russ.) DOI:10.20996/1819-6446-2018-14-6-816-825.

18. Edgell H., Moore L.E., Chung C. et al. Short-term cardiovascular and autonomic effects of inhaled salbutamol. Respiratory Physiology & Neurobiology. 2016;231:14-20. DOI:10.1016/j.resp.2016.05.014.

19. Sin D.D., Man S.F.P. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proceedings of the American Thoracic Society. 2005;2(1):8-11. DOI:10.1513/pats.200404-032MS.

20. Corlateanu A., Covantev S., Mathioudakis A.G., et al. Prevalence and burden of comorbidities in Chronic Obstructive Pulmonary Disease. Respiratory investigation. 2016;54(6):387-96. DOI:10. 1016/j.resinv.2016.07.001.

21. Mannino D.M., Thorn D., Swensen A., Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. European Respiratory Journal. 2008;32(4):962-9. DOI:10.1183/09031936.00012408.

22. Boytsov S.A., Loukianov M.M., Yakushin S.S., et al. Cardiovascular diseases registry (RECVASA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatientpolyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50. (In Russ) DOI:10.15829/1728-8800-2014-6-3-8.

23. Sin D.D., Man S.F.P. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation. 2003;107(11):1514-9. DOI:10.1161/01.CIR.0000056767.69054.B3.


For citation:


Kurekhyan A.S., Smirnova M.I., Gorbunov V.M., Koshelyaevskaya Y.N., Deev A.D., Loukianov M.M. Prevalence and Characteristics of Blood Pressure Phenotypes in Patients with Hypertension and Chronic Respiratory Diseases (Study of Ambulatory Practice Data of a Cardiologist). Rational Pharmacotherapy in Cardiology. 2020;16(4):542-549. (In Russ.) https://doi.org/10.20996/1819-6446-2020-08-20

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