Hypertension: A trigger or a consequence of exacerbations in COPD?

Abstract

Hypertension is one of the most common diseases in the world, affecting 30–40% of the adult population. It is commonly associated with other comorbidities such as chronic obstructive pulmonary disease (COPD) which may influence the course of the disease. Besides, airflow limitation in COPD is a predictor of future risks of hypertension and cardiovascular events. In fact, COPD is now understood as a systemic inflammatory disease, with a focus of inflammation on the lungs. Assess the prevalence of hypertension in COPD patients. It is a randomized prospective study including 43 out-patient, aged from 50 to 92 years, affected with COPD. Each patient was subjected for 12-lead ECG, 24-hour Holter for arrhythmia detection and two-dimensional echocardiography. We compared a group G1 of patients with frequent exacerbations of COPD ( n = 23) to a group G2 of patients with infrequent exacerbations of COPD ( n = 20). The mean of age was 71 years in G1 vs. 65 years in G2. Also, a high significant difference was seen on comparing the mean of duration of COPD (5.57 years in G1 vs. 3 years in G2) ( P = 0.02). Half of the patients of G1 had associated comorbidities vs. 12% in G2 ( P = 0.01). From which hypertension accounted for 12% in G1 vs. 5% in G2 ( P = 0.01). In total, 18% presented with ischemic cardiovascular disease in G1 vs. 6% in G2. Besides, 24% of our patients had diabetes mellitus in G1 vs. 1% in G2. Most of the patients of G1 were asymptomatic (60% vs. 20% in G2). Six percent of the patients presented with dyspnea in G1 vs. 5% in G2. While 14% of our patients complained of chest pain vs. 5% in G2. There was a significant difference on comparing the mean of PaO2 (56 mmHg in G1 vs. 65 mmHg in G2) ( P = 0.015). In our study, the hypertension was significantly more common in the group of patients with frequent exacerbations of COPD underlying a pathophysiological link between COPD and hypertension which may be explained by an endothelial dysfunction.