Hypertension and COPD are common diseases associated with significant morbidity and mortality, explains Bernard MY Cheung, PhD, FRCP. “Hypertension is the leading modifiable risk factor for cardiovascular diseases (CVD) such as strokes and heart attacks,” he says. “People with COPD, who are mainly smokers, have shortness of breath but they also have more CVD, which is partly due to smoking.”

Compared with people without COPD, he adds, patients with COPD have a two-fold or greater increase in CVD hospitalization and mortality. “COPD is strongly linked with CVD, including stroke, ischemic heart diseases, and atrial fibrillation.”

Previous investigations examining the relationship between hypertension and COPD have primarily concentrated on men or smoking populations, Dr. Cheung says. One study, he says, showed that COPD is independently linked with hypertension in men aged 40 and older. Another revealed that hypertension is more common among patients with severe COPD aged 45 years and older but not younger. “However, there is not a lot of research into the link between hypertension and COPD in the general population,” Dr. Cheung notes.

Link Especially Significant Among Heavy Smokers Under 60

To fill this gap in knowledge, Dr. Cheung and colleagues published a study in Chronic Obstructive Pulmonary Disease. They utilized the NHANES (1999-2018), analyzing data from 46,804 adults. The analysis was adjusted for demographics, socioeconomic factors, smoking, diabetes, BMI, and medication use, including inhaled corticosteroids and methylxanthines.

“We found a significant association between hypertension and COPD, especially among adults younger than 60 who were current heavy smokers,” Dr. Cheung observes. “This means that in patients with COPD, you need to check for and treat hypertension to prevent CVD.”

In this study, Dr. Cheung and colleagues note, the diagnosis of COPD relied on a questionnaire survey without including standard investigations such as spirometry, as spirometry was only performed in selected years (2007-2012) in NHANES. They conducted a sensitivity analysis using different definitions of COPD with NHANES data (2007-2012). Among current heavy smokers, COPD was positively linked with hypertension after adjustments (OR, 1.25 [95% CI, 1.01-1.58]; P=0.04). “The association between hypertension and COPD remained significant across the various definitions of COPD (Table),” says Dr. Cheung.

Study Highlights Need for Smoking Cessation Programs

The researchers point out that their study offers justification for the implementation of management strategies targeting both hypertension and COPD, with the aim of alleviating the burdens associated with these comorbidities. “Our research has revealed an association between hypertension and COPD in current heavy smokers, highlighting the necessity of smoking cessation,” Dr. Cheung says.

The study team notes that it would be useful to know the percentage of patients with COPD who have undiagnosed hypertension. “People with hypertension may have no symptoms, so they may not be aware of their condition and fail to seek medical help,” says Dr. Cheung. “People with COPD and undiagnosed hypertension are at a high risk for strokes and heart attacks. Patients with COPD should have their blood pressure checked regularly. If it is elevated, it should be controlled by lifestyle measures, such as healthy diet and regular physical activity plus medications if necessary.”