Arterial hypertension with comorbid chronic obstructive pulmonary disease: relationship between tolerance to physical exercise and structural and functional state of the heart.




arterial hypertension, chronic obstructive pulmonary desease, ambulatory blood pressure monitoring, pulsoxymetry, 6-minutes walking test


The aim of the study was to establish the relationship between tolerance to exercise, oxygen saturation, and structural and functional cardiac status in patients with hypertension in combination with COPD. This study included 120 patients with primary arterial hypertension of stage I-II, grade 1, 2, and 3 in combination with COPD of grades 2 and 3 and clinical groups A, B, C, D, consisting group 1; group 2 – 30 patients with primary hypertension, and group 3 – 30 patients with COPD; group 4 – 30 practically healthy people representative by age and sex. Research methods included general clinical examination (collection of complaints, anamnestic data) and instrumental research methods: electrocardiography (ECG), echocardiography, measurement of ambulatory blood pressure (BP) profile (ABPM), spirometry, pulsoxymetry (SpO2), 6-minutes walking test (6MWT). On examination of 120 patients with stage I-II, grade 1 hypertension was established in 19 (15.8%), grade 2 was in 83 (69.2%) and grade 3 was in 18 (15%) patients, respectively. COPD in clinical group A was diagnosed in 10 (8.3%), B – in 51 (42.5%), C – in 18 (15%) and D - in 41 (34.2%) patients, respectively. The most common was AH stage 2 with COPD in clinical group B – 35 (29.2%) cases and D – 31 (25.8%) cases. The 24-hour average systolic BP (SBP) in patients of the main group was 165 [144;178] mmHg, and the diastolic BP (DBP) was 103 [94;111] mmHg. The daytime average SBP was 160 [140;180] mmHg, and the DBP was 105 [93;117] mmHg accordingly. The night-time average SBP was 165 [155;175] mmHg, DBP – 100 [95;105] mmHg, heart rate (HR) – 83 [76;88] minutes, respiration rate (RR) – 21 [19;24] minutes. Decreases in index of chronotropic reserve (ICR) and the index of inotropic reserve (IIR) and load index indicate an increase in myocardial oxygen demand during exercise. There was an inverse correlation of IIR with SBP at rest (r= –0.42; p˂0.05) and a direct correlation with age (r=0.28; p˂0.05), which is significantly different from the control group. A direct correlation was found between the double product (DP) before and after exercise (r=0.43; p˂0.05), which indicated an increase in consumption of oxygen by the myocardium. We found a direct correlation between left atrium (LA) and the ratio of expiratory volume per 1 sec (FEV1) to the forced lung capacity (FEV) – FEV1/FVC (r=0.32; p˂0.05), which indicates the effect of the severity of bronchial obstruction on the level of left ventricular (LV) overload in patients with hypertension combined with COPD. The inverse correlation between thickness of the posterior wall of the LV (RVWT) and FEV1/FVC (r= -0.32; p˂0.05) indicates the contribution of disorders of bronchial patency and intrathoracic pressure with the level of BP to the development of concentric remodeling and LV hypertrophy. The inverse correlation between SV and COPD Assessment Test (CAT) (r= -0.32; p˂0.05) indicates an additional effect of COPD clinical severity on central hemodynamics in patients with hypertension. This relationship between the ventilatory and hemodynamic parameters is confirmed by the inverse correlation of  HR and  FVC  (r= –0.33; p˂0.05)),  left  ventricular  internal  dimension (LVEDD) of LV and  CAT (r= –0.24; p˂0.05)), stroke volume (SV) and Modified British Medical Research Questionnaire (mMRC) (r= –0.42; p.00.05), CAT and pack years (r=0.33; p˂0.05), inverse correlation between CAT and mMRC and FEV1, FVC and FEV1/FVC (r= -0.40;p˂0.05 and r= -0.45; p˂0.05), respectively. Linear regression analysis showed that changes in SV LV, LVEDD and SpO2 were dependent predictors of patient’s worsening state according to CAT (p˂0.05). The direct correlation was established between the desaturation (ΔSpO2) and ΔDP (r=0.48) and the inverse of ΔSBP (r= -0.29), 6MWT (r= -0.45), ICR (r= -0.34) and IIR (r= -0.29), which indicates a pronounced effect of hypoxemia on hemo­dynamics in patients with hypertension in combination with COPD. Comprehensive determination of cardiorespiratory reserve by 6-minute walk test, pulse oximetry and ambulatory blood pressure monitoring in patients with hypertension in combination with COPD makes it possible to establish disadaptation of the body to physical activity due to hypoxemia, decrease in the index of chrono- and inotropic reserves, which is an indication for administering appro­priate therapy. In patients with hypertension combined with COPD, the degree of desaturation, stroke volume, end-diastolic parameters of the left ventricle, maximal size and volume of the left atrium, as well as remodeling of the left heart sections in the concentric direction can be considered as independent predictors of prognosis. The 6-minute walk test with desaturation can be used as an additional method of personalizing rehabilitation measures in patients with hypertension in combination with COPD.

Author Biographies

T. Z. Burtniak

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Therapeutic, cardiology and family medicine
30-ty richchia Peremogy sq., 2, Kryvyi Rih, Dnipropetrovsk region, 50056, Ukraine

V. A. Potabasniy

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Therapeutic, cardiology and family medicine
30-ty richchia Peremogy sq., 2, Kryvyi Rih, Dnipropetrovsk region, 50056, Ukraine

V. I. Fesenko

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Therapeutic, cardiology and family medicine
30-ty richchia Peremogy sq., 2, Kryvyi Rih, Dnipropetrovsk region, 50056, Ukraine


Feshchenko YuI, Gavrisyuk VK, Dzublik OYa, Mostovoy YM, Pertseva TO, Polyanska MO, Yachnik AI, Yashina LO. Adapted clinical setting: chronic obstructive pulmonary disease (Part 1). Ukrainian Pulmonary Journal. 2019;2:5-17.

Machado FVC, Biscaa GW, Moritaa AA, Rodri­guesa A, Probsta VS, Furlanettoa KC, Pitta F, Hernan­des NA. Agreement of different reference equations to classify patients with COPD as having reduced or preserved 6MWD. Pulmonol. 2018;24(1):16-22. doi:

Arhіpkіna OL. Peculiarities of clinical interrup­tion of chronic obstructive burial of leg in ailments with hypertension. Medicnі perspektivi. 2019;24(2):40-45. doi:

Chazova IE, Lazareva NV, Oshchepkova EV. 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):4-10. doi:

Sіrenko JuM, Mіshhenko LA, Yena LM, Koval SM, Radchenko GD, Rekovets OL. Classification and standards of medical care for patients with arterial hypertension of the Association of Cardiologists of Ukraine. Arterialnaia hipertenziia. 2018;4(60):26-47. doi:

García-Talaveraa I, Figueira-Gonc¸alvesa JM, Gurbania N, Pérez-Méndezb L, Pedrero-García A. Clini­cal characteristics of COPD patients with early-onset desaturation in the 6-minute walk test. Pulmonol. 2018;24(5):275-9. doi:

André S, Conde B, Fragoso E, Boléo-Tomé JP, Areias V, Cardosog J. COPD and Cardiovascular Disease Pulmonol. 2019;25(3):168-76. doi:

ESH/ESC Guidelines For The Management Of Arterial Hypertension; 2018.

Gino Iannucci, Luigi Petramala, Giuseppe La Tor­re, Barbara Barbaro, Clara Balsano, Pietro Giacomo Curatulo, Francesco Amadei, Marino Paroli, Antonio Con­cistrè, Claudio Letizia. Evaluation of tolerance to ambulatory blood pressure monitoring. Analysis of dip­ping profile in a large cohort of hypertensive patients. 2017;Dec. 96(50):e9162. doi:

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, mana­gement and prevention of chronic obstructive pulmonary disease. Medical Communications Resources; 2019. doi:

Atul Malhotra, Alan R. Schwartz, Hartmut Schneider, Robert L. Owens, Pamela DeYoung, MeiLan K. Han Research Priorities in Pathophysiology for Sleep-disordered Breathing in Patients with Chronic Obstructive Pulmonary Disease. American Thoracic Society Documents. Am J Respir Crit Care Med. 2018;197(3):289-99. doi:

Kovalenko VM. The problem of comorbidity in cardiology. UKR. MED. ChASOPYS. 2019;5.

Marwick TH, Gillebert TC, Aurigemma G, Chirinos J. Recommendations on the use of echo­cardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). Eur. Heart J. Cardiovasc. Imag. 2015;16:577-605. doi:

Adasheva TV, Babak SL, Gorbunova MV, Zadionchenko VS, Zykov KA, Karoli NA, Li VV, Rebrov AP. National clinical guidelines: diagnosis and treatment of patients with chronic obstructive pulmonary disease and hypertension; 2017.

Potabashnii VA. New approach until the sign of the geometrical left whore in case of chronic heart failure in patients with hypertension and IHD in accordance with COPD. Medicni perspektivi. 2016;21(2):39-46. doi:

Potabashnii VA. The phenotypes of chronic heart failure in patients with ischemic heart disease combined with chronic obstructive pulmonary disease. Medicni perspektivi. 2018;23(3 part1):161-71. doi:

Peter Alter, Barbara A, Mayerhofer, Kathrin Kahnert, Henrik Watz. Prevalence of cardiac comor­bidities, and the irun derdetection and contribution to exertional symptoms in COPD: results from the COSYCONET cohort. International Journal of Chronic Obstructive Pulmonary Disease. 2019;14.2163-72. doi:

Ye C, Younus A, Malik R, Roberson L, Shaha­ryar S. Subclinical cardiovascular disease in patients with chronic obstructive pulmonary disease: a systematic review. QJM: An International Journal of Medicine. 2017;341-49. doi:

Honeyford K, Bell D, Chowdhury F, Quint J, Aylin P, Bottle A. Unscheduled hospital contacts after inpatient discharge: A national observational study of COPD and heart failure patients in England. PLoS ONE 2019;14(6):e0218128. doi:


How to Cite

Burtniak TZ, Potabasniy VA, Fesenko VI. Arterial hypertension with comorbid chronic obstructive pulmonary disease: relationship between tolerance to physical exercise and structural and functional state of the heart. Med. perspekt. [Internet]. 2019Dec.26 [cited 2024Feb.21];24(4):59-68. Available from: