关键词: 慢性阻塞性肺疾病, 高血压, 心血管事件, 影响因素, 血压

Abstract:

Objective To analyze the incidence of cardiovascular events among patients with comorbid chronic obstructive pulmonary disease （COPD） and hypertension （HTN）， as well as to identify the associated influencing factors. Methods A retrospective analysis was conducted on patients diagnosed with primary hypertension （HTN group， n = 64）， chronic obstructive pulmonary disease （COPD group， n = 64）， and concomitant primary hypertension and COPD （combined group， n = 64） at our hospital between December 2021 and January 2025. Cardiovascular event incidence， pulmonary function parameters?including forced vital capacity （FVC）， forced expiratory volume in 1 second （FEV1）， peak expiratory flow （PEF）， and percent predicted FEV1 （FEV1% pred）?and blood pressure levels （systolic blood pressure ［SBP］， diastolic blood pressure ［DBP］） were compared across the three groups. Kaplan?Meier curves were constructed to illustrate and compare the cumulative incidence of cardiovascular events. Covariance analysis was performed to assess the impact of hypertension on pulmonary function， and Cox proportional hazards regression was employed to identify factors associated with cardiovascular outcomes. Results The total incidence rate of cardiovascular events in the HTN group was 14.06%， which was significantly lower than that in the COPD group （29.69%） and the combined HTN?COPD group （48.44%） （P<0.05）. A highly significant difference was observed in the cumulative incidence rates across the three groups （P < 0.05）. Specifically， the COPD group exhibited a higher cumulative incidence than the HTN group （P < 0.05）， while the combined group showed the highest incidence， exceeding both the COPD and HTN groups （P < 0.05）. Pulmonary function parameters?including FVC， FEV1， PEF， and FEV1% pred?were significantly higher in the HTN group compared to both the COPD and combined groups （P < 0.05）. Moreover， these indices were also higher in the COPD group than in the combined group （P < 0.05）. Systolic and diastolic blood pressure （SBP and DBP） levels in the combined group were significantly elevated compared to both the HTN and COPD groups （P < 0.05）， and SBP and DBP in the HTN group were higher than those in the COPD group （P < 0.05）. After adjusting for potential confounders， the intergroup difference in FVC remained statistically significant （P < 0.05）， and the effect of group on FEV1% pred was particularly robust （partial η2 = 0.754， P < 0.05）. Compared with patients without cardiovascular events， those who experienced events differed significantly by disease type （P < 0.05）. The proportions of patients with HTN alone and HTN combined with COPD were higher in the event group than in the non?event group （P < 0.05）. Additionally， FVC and FEV1% pred were lower in the event group， whereas SBP and DBP were higher （all P < 0.05）. Multivariate analysis identified disease type， FEV1% pred， and SBP as independent predictors of cardiovascular events （P < 0.05）. Decision tree analysis further highlighted that the coexistence of HTN and COPD constitutes a critical determinant in cardiovascular risk stratification. Conclusions The incidence of cardiovascular events in patients with COPD combined with HTN was significantly higher than in those with either condition alone. Furthermore， the coexistence of these diseases， along with impaired lung function （as indicated by reduced FEV1% predicted） and increased SBP， were independent risk factors for cardiovascular events.

Key words: chronic obstructive pulmonary disease, hypertension, cardiovascular events, influencing factors, blood pressure