Comorbidities in pulmonary hypertension. a dangerous association
G Sorasio, S C N Nicolas Silva Cromme, J S Julieta Sorciettti, M F Figueroa Manuel, P C M Costas Martignano Pablo, T V Vanegas Tomas, P V Vargas Paul, F I Fernandez Ianina, M M Mercado Mariela, L A Lescano AdrianAbstract
Abstract
Introduction Pulmonary hypertension (PH) is a condition with high morbidity and mortality despite the addition of various therapeutic strategies. The presence of comorbidities in this population has been associated with reduced survival, decreased functional capacity, and a worse prognosis. These comorbidities can occur in more than 70% of patients with pulmonary arterial hypertension and, in some cases can make it difficult to differentiate from other PH groups and mask symptoms.
Objectives
Describe the presence of comorbidities in a population of patients with PH diagnosed by right heart catheterization
Materials and Methods
Multicenter, descriptive, analytical, prospective study that included patients diagnosed with PH by right heart catheterization (mean pulmonary artery pressure > 20 mm Hg, pulmonary vascular resistance > 2 WU, and pulmonary capillary wedge pressure < 15 mm Hg). Demographic, clinical, echocardiographic, hemodynamic, and treatment-based characteristics were analyzed. Comorbidities included age over 65 years, hypertension, diabetes, obesity (defined as body mass index greater than 30 kg/m²), left ventricular hypertrophy (LVH), coronary artery disease (CAD), atrial fibrillation, chronic renal failure (CRF) (defined as a reduction in estimated creatinine clearance < 60 ml/min/1.73 m² by the CKD-EPI formula), and chronic obstructive pulmonary disease (COPD). Qualitative variables are expressed as a percentage (%), and quantitative variables as mean or median with standard deviation or interquartile range, depending on the distribution. Statistical significance was defined as a p value less than 0.05 and the STATA 14 program was used.
Results
451 patients diagnosed with PH between January 2012 and March 2025 were included. The mean age was 62 ± 17 years, and 66.44% were female. 48% were in functional class III/IV. 55.7% belonged to group 1, 53.67% were classified as intermediate risk, and 18.26% as high risk. 224 patients completed all the comorbidities studied. 56.5% were older than 65 years. 67.5% of the patients (143) were hypertensive, obesity was present in 3.1% (12 p), diabetes in 5.2% (34 p), coronary artery disease in 10.3% (23 p), LVH in 29.1% (60 p) and atrial fibrillation in 12.4% (28 p). CRF was present in 13.2% (29 p) and COPD in 23.2% (52 p). In 22% of the patients, the presence of 3 or more associated comorbidities was determined.
Conclusion
Our patient population with pulmonary hypertension was older, had advanced functional class, and was at intermediate risk. Comorbidities were frequent (greater than 10%), with a predominance of cardiovascular phenotypes (higher prevalence of hypertension, atrial fibrillation, left ventricular hypertrophy, and coronary artery disease) and a high percentage of COPD. Additionally, approximately one-quarter of the patients presented with three or more comorbidities.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.