ASSESSMENT OF TOTAL CARDIOVASCULAR RISK IN PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBID CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim – to determine the total cardiovascular risk (CVR) in patients with AH and comorbid COPD. Material and Methods. The study included 120 patients with hypertension stage II, grade 2, 3 and 3 in combination with COPD grade II-III and clinical groups A, B, C, D. The study methods included general clinical examination (collection of complaints, medical history, clinical examination, anthropometric parameters), laboratory (blood lipids, blood glucose, blood creatinine, calculated glomerular filtration rate according to CKD-EPI) and instrumental methods (electrocardiography, Doppler echocardiography, ambulatory blood pressure monitoring, spirometry). Results. The SCORE scale revealed that in one case there were no individuals with low CVR among patients with AH and comorbid COPD. In the patient group, 57.5 % were found to have a moderate CVR, 36.7 % had a high CVR, and a very high risk was established in 5.8 % of cases. Pulse pressure, aortic stiffness index, ECG and EchoCG signs of left ventricular hypertrophy, and glomerular filtration rate were analyzed to detect asymptomatic hypertensive target organ damage. The patients were stratified by determining the total CVR. It was found that there were no patients with a moderate degree of CVR in group 1, the number of patients with a high degree of CVR increased to 85.0 %, and a very high degree of CVR increased to 15.0 %. Conclusion. The cardiovascular risk in patients with AH and comorbid COPD depends not only on the degree of AH, the profile of cardiac risk factors and target organ damage, but also on the degree and clinical group of COPD. An increase in overall cardiovascular risk has been revealed, which requires the inclusion of COPD to the prognostic extracardiac risk factors in patients with AH.

Introduction. Arterial hypertension (AH) is a major cause of mortality, premature morbidity and disability, and a key risk factor (FR) for coronary heart disease (CHD), cerebrovascular disease, heart failure (CHF), chronic kidney disease and dementia [1]. According to modern AH guidelines, special attention is paid to the SCORE scale, which is simple, valid and informative enough, but still does not cover a wide range of FR, hypertensive target organ damage and associated clinical conditions. Today, the concept of total (global) cardiovascular risk (CVR) is generally recognized, according to which FR are not specified in the SCORE scale (fasting plasma glucose, excessive body weight, a heavy family history of AH, resting heart rate over 80/min) are taken into account, left ventricular hypertrophy (LVH) according to electrocardiography (ECG) and Doppler echocardiography (DECG), glomerular filtration rate (GFR) according to CKD-EPI formula, arterial stiffness), which actualizes further research of this issue, in the case of cohort patients with AH and comorbid COPD.
The aim -to determine the general cardiovascular risk in patients with AH and comorbid COPD.
Materials and Methods. The study included 120 patients with hypertension stage II, grade 2, 3 and 3 in combination with COPD grade II-III and clinical groups A, B, C, D. All patients provided consented to participate in the study in accordance with the Declaration of Helsinki 2000.
Methods of investigation included general clinical examination (collection of complaints, medical history, clinical examination, anthropometric parameters), laboratory (blood lipids, blood glucose, blood creatinine, calculation of GFR according to CKD-EPI formula) and instrumental methods of investigation: ECG, DECG, ambulatory monitoring of blood pressure (BP), spirometry. AH was divided according to the stage and degree of arterial pressure increase in accordance with the Order of the Ministry of Health of Ukraine No. 384 of 24.05.2012 and recommendations of the European Society of Cardiology and the Ukrainian Association of Cardiologists (2018) [3,4,5]. According to the gravity of COPD patients were Results and Discussion. Table 1 presents the structure of CVR factors in patients with AH and comorbid COPD according to the general guidelines with AH of the European Society of Cardiology and the European Society of Hypertension (2018) and the project of the All-Ukrainian Association of Cardiology (2018) [3,4].

Огляди літератури, оригінальні дослідження, погляд на проблему, випадок з практики, короткі повідомлення
We performed SCORE stratification of CVD in the main group. We found that no patients with AH and comorbid COPD had low CVD, 57.5 % had moderate CVD, 36.7 % had high CVD, and very high risk was found in 5.8 % of the SCORE patients.
Thus, the regratification of patients, determining the total CVR, revealed that in the experimental group there were no patients with a moderate CVR, the number of patients with a high CVR increased to 85.0 %, and with a very high CVR to 15.0 %.
When comparing the results of the SCORE total CVR determination, taking into account laboratory parameters and factors of asymptomatic hypertensive target organ damage, an increase in patients with a high and very high degree of CVR was noted. Pulse pressure (PP), aortic stiffness index (ASI), ECG and EchoCG signs of hypertension and GFR were analysed to detect asymptomatic hypertensive target organ damage, and the results are shown in Table 2.
There was a direct correlation between CVR and degree of AH (r=0.24; p<0.05), with age (r=0.33; p<0.05) and GFR (r=-0.35; p<0.05), which had a high significant effect on establishing CVR in patients with this comorbid pathology.
The degree of CVR has been shown to require a more careful approach to determining the vital prognosis of patients with comorbid pathology in order to prevent the reduction of cardiovascular complications and the occurrence of respiratory exacerbations.

Conclusions. Cardiovascular risk in patients with
AH and comorbid COPD depends not only on the degree of AH, the profile of cardiac risk factors and target organ damage, but also on the degree and clinical group of COPD.
Prospects for future research. An increase in overall cardiovascular risk, with COPD as a prognostic extracardiac risk factor in patients with AH, has been demonstrated. 10. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (Report 2020) // Medical Communications Resources. -2020. -Available from: https://goldcopd.org/ gold-reports.