CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION: VASCULAR WALL AS THE TARGET ORGAN IN COMORBID PATIENTS

Studies of endothelial dysfunction in patients with respiratory diseases have become relevant in recent years. Perhaps endothelial dysfunction and high arterial stiffness bind bronchopulmonary and cardiovascular diseases.

Aim. To reveal features of disturbances of arterial wall vasoregulatory function in patients with chronic obstructive pulmonary disease (COPD) in the presence and absence of arterial hypertension (HT).

Material and methods. The study included 50 patients with COPD with normal blood pressure (BP) and 85 patients with COPD and HT. Control group was presented by 20 practically healthy men comparable in age with COPD patients. Tests with reactive hyperemia (endothelium-dependent dilation) and nitroglycerin (endothelium-independent dilation) were performed in order to evaluate endothelium function. The number of desquamated endotheliocytes in the blood was determined.

Results. In patients with COPD and HT in comparison with COPD patients without HT and healthy individuals more pronounced damages of the vascular wall, endothelium vasoregulatory function disturbances and a tendency to the reduction in endothelium-dependent vasodilation were determined both during COPD exacerbation and remission. These differences were most pronounced during the COPD exacerbation. In patients with COPD and HT in comparison with COPD patients without HT the damage of the vascular wall was more pronounced during the remission and endothelium-dependent dilatation disorder – during the exacerbation. The revealed disorders in patients with COPD and HT were associated with smoking status (r=0.61, p<0.01), severity of bronchial obstruction (r=-0.49, p<0.05), and hypoxemia (r=-0.76, p<0.01). We noted relationships between the parameters of 24-hour BP monitoring and remodeling of the brachial artery (r=0.34, p<0.05), endothelium lesion (r=0.25, p<0.05), and impairment of its vasoregulating function (r=-0.58, p<0.05). At that, the following parameters were important: the average systolic and diastolic BP levels, the BP load and variability indices, the time and rate of morning surge in systolic BP, and the circadian rhythm of BP.

Conclusion. The obtained data show the aggravation of the severity of the vascular wall damages and the reduction in the endothelium vasoregulating activity in patients with COPD after development systemic HT. This effect is more evident during the exacerbation of bronchopulmonary disease. 

1. Global Strategy for diagnosis, management and prevention of COPD. Scientific information and recommendations for COPD programs. Updated 2013. Available at: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013Feb13.pdf. Checked by Jun 05, 2017.

2. Chandy D., Aronow W.S., Banach M. Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease. Integr Blood Press Control. 2013;6:101-9.

3. Karoli N.A., Rebrov A.P. Arterial hypertension in patients with bronchial asthma and chronic obstructive pulmonary disease. Klinitsist. 2011;2:20-30. (In Russ.) [Кароли Н.А., Ребров А.П. Артериальная гипертензия у пациентов с бронхиальной астмой и хронической обструктивной болезнью легких. Клиницист. 2011; 2:20-30].

4. Chandra D., Gupta A., Strollo P.J.Jr, et al. Airflow Limitation and Endothelial Dysfunction. Unrelated and Independent Predictors of Atherosclerosis. Am J Respir Crit Care Med. 2016;194(1):38-47.

5. Anderson T.J., Uehata A., Gerhard M.D., et al. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995;26:1235-41.

6. Neunteufl T., Katzenschlager R., Hassan A., et al. Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease. Atherosclerosis. 1997;129:111-8.

7. Celermajer D.S., Adams M.R., Clarkson P., et al. Passive smoking and impared endothelium-dependent arterial dilatation in healthy young adults. N Engl J Med. 1996;334:150-4.

8. Hladovec J. Circulating endothelial cells as a sign of vessel wall lesions. Physiol Bohemoslov. 1978;27:140-4.

9. Majanskaja S.D., Antonov A.R., Popova A.A., et al. Endothelial dysfunction markers in young patients with silent arterial hypertension. Rossiyskiy Kardiologicheskiy Zhurnal. 2004;6:28-32. (In Russ.) [Маянская С.Д., Антонов А.Р., Попова А.А., и др. Маркеры дисфункции эндотелия сосудов у лиц молодого возраста с латентной артериальной гипертонией. Российский Кардиологический Журнал. 2004;6:28-32].

10. Nebieridze D.V., Oganov R.G. Endothelial dysfunction as a risk factor of atherosclerosis, the clinical significance of its correction. Kardiovaskulyarnaya Terapiya i Profilaktika. 2003;3:86-9. Russian (Небиеридзе Д.В., Оганов Р.Г. Дисфункция эндотелия как фактор риска атеросклероза, клиническое значение ее коррекции. Кардиоваскулярная Терапия и Профилактика. 2003;3:86-9].

11. Britov A.N. Endothelial dysfunction and role nitrates and beta-blockers in its correction in ischemic heart disease. Rational Pharmacotherapy in Cardiology. 2016;2:234-8. (In Russ.) [Бритов А.Н. Эндотелиальная дисфункция и роль нитратов и бета-блокаторов в ее коррекции при ишемической болезни сердца. Рациональная Фармакотерапия в Кардиологии. 2016;2:234-8].

12. ThijssenD.H., Black M.A., Pyke K.E., et al. Assessment of flow mediated dilation in humans: a methodological and physiological guideline. Am J Physiol Heart Circ Physiol. 2011;300: H2-H12.

13. Ahmineeva A.H., Polunina O.S., Voronina L.P. The incidence of endothelial dysfunction in the syndrome of cardiorespiratory mutual weaning. Kubanskii Nauchnyi Meditsinskii Vestnik. 2013;5:35-6. (In Russ.) [Ахминеева А.Х., Полунина О.С., Воронина Л.П. Частота встречаемости эндотелиальной дисфункции при синдроме кардиореспираторного взаимного отягощения. Кубанский Научный Медицинский Вестник. 2013;5:35-6].