INDICATORS OF APOPTOTIC ACTIVITY IN PATIENTS WITH COMBINED STAGE II ESSENTIAL HYPERTENSION AND STAGE II-III CHRONIC OBSTRUCTIVE PULMONARY DISEASE BASED ON COMORBIDITY CLINICAL FEATURES

The purpose of the study is to improve the diagnosis, prognosis and treatment of chronic obstructive pulmonary disease stage II-III in combination with essential hypertension stage II based on the study of the clinical and pathogenetic role of apoptosis markers. Introduction. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic condition characterized by recurrent exacerbations that are the primary reason for COPD patients to seek medical care, accounting for hospitalizations and contributing to mortality rates. Frequent exacerbations are associated with reduced quality of life and poorer prognoses. Each episode accelerates the progression of COPD, exacerbating respiratory failure and complicating its management. Severe exacerbations pose a significant threat to life and are a leading cause of fatal outcomes. Essential hypertension (EH), often observed in the course of COPD, depends on the severity of the pulmonary pathology and bronchial tree obstruction. In such cases, it is termed pulmonogenic hypertension, occurring in 18–30% of cases. Conversely, COPD may develop under pre-existing hypertensive disease or symptomatic arterial hypertension. The interplay of these conditions substantially influences their clinical course and outcomes. The study aims to enhance the diagnosis, prognosis, and treatment of stage II–III COPD combined with stage II essential hypertension by investigating the clinical and pathogenetic role of apoptosis markers. Materials and methods. The results of the study are based on the data of a comprehensive examination and dynamic observation of 121 patients of both sexes, aged from 30 to 67 years, who were examined over the period 2016-2018 years and underwent inpatient treatment at the Zaporizhzhya Regional Clinical Hospital. The patients were divided into 3 groups, comparable by age and sex: the main group included 40 patients with chronic obstructive pulmonary disease stage II-III (moderately severe course) in combination with essential hypertension stage II of various cardiovascular risk (average age 50.81±0.99 years); the 1st comparison group included 48 patients with chronic obstructive pulmonary disease stage II-III (average age 50.7±1.53 years); the 2nd comparison group consisted of 33 patients with essential hypertension stage II of various cardiovascular risk (average age 51.68±1.22 years). To determine the reference values ​​of the studied indicators, 20 healthy people were examined as a control group. Results. The analysis of the dynamics of cysteine proteases revealed a statistically significant increase in these apoptosis markers in patients with comorbid chronic obstructive pulmonary disease (COPD) and essential hypertension (EH). This elevation was associated with advancing age, longer disease duration, and greater severity of both COPD and EH. Regression analysis indicated a strong relationship between blood caspase-7 levels and future exacerbation risks, as measured by the SAT score. The relationship is best described by a quadratic regression model, with the following parameters: R = 0.73, R² = 0.53, normalized R² = 0.51, F = 39.56, p < 0.001. Conclusion. Apoptotic processes play a significant role in the development of exacerbations in the comorbid course of chronic obstructive pulmonary disease and essential hypertension.