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Año 12 N° 33  
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Tercera Época  
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REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021  
Angela Yurievna Dolova et al.// Analysis of the structure and severity of comorbid pathology … 288-296  
DOI: http://dx.doi.org/10.46925//rdluz.33.20  
Analysis of the structure and severity of comorbid pathology in  
patients with arterial hypertension  
Angela Yurievna Dolova *  
Inga Arsenovna Kodzokova **  
Aksana Muhamedovna Kardangusheva ***  
Irina Khasanbievna Borukaeva ****  
Fatima Batalovna Gamaeva *****  
Elizaveta Alikovna Sharibova ******  
Asiyat Nikolaevna Malukhova *******  
ABSTRACT  
The purpose of the research is to study the structure and severity of comorbid pathology in hospitalized  
patients with arterial hypertension. Material and methods. The study included 140 adult patients (29% men  
and 71% women) with arterial hypertension and comorbidity receiving therapy in the cardiology department.  
The average age of the patients was 64.3 ± 12.0 years. The Charlson index was used to assess comorbidity.  
Results. The average Charlson index in our study was 3.97 ± 2.0 points. Moderate and severe comorbidity was  
observed in 77.6% of patients with arterial hypertension. When analyzing the frequency of concomitant  
pathology, one disease was detected in 7% of the examined, two in 28%, three in 14%, four in 23%, five or more  
in 28%. The structure of concomitant pathology is represented mainly by chronic cerebral ischemia (26.3%),  
rhythm and conduction disturbances (20%), diseases of the bronchopulmonary (14.8%) and digestive (12.7%)  
systems. Analysis of risk factors for comorbidity revealed heredity aggravated by cardiovascular diseases in  
33.3% of patients with arterial hypertension, smoking in 7.3%, overweight in 27%, obesity in 62%, and  
abdominal obesity in 87%. Obesity was not diagnosed in all men and 85.4% of women, which indicates that  
this risk factor for comorbidity was not taken into account. Conclusion. The introduction into the practice  
of managing patients with arterial hypertension and comorbidity of scoring the presence of concomitant  
diseases by calculating the Charlson comorbidity index will increase the accuracy of assessing the prediction  
of their ten-year survival. Identifying and correcting the main risk factors for comorbidity and concomitant  
pathology in patients with arterial hypertension can reduce disability and mortality.  
KEY WORDS: arterial hypertension; comorbidity; cardiovascular diseases; Charlson index; risk factors.  
*
6th year student of the specialty "General Medicine" of the Faculty of Medicine Kabardino-Balkarian State University  
named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0001-6890-6544. E-mail: kardangush@mail.ru  
*
*4th year student of the specialty "General Medicine" of the Faculty of Medicine Kabardino-Balkarian State University  
named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0001-8158-6098  
*
** Associate Professor, Head of the Department of Public Health, Health Care and Preventive Medicine Kabardino-  
Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0002-2960-7928  
*
*** Associate Professor, Professor of the Department of Normal and Pathological Human Physiology Kabardino-  
Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0003-1180-228X  
*
****Candidate of Veterinary Sciences, Assistant of the Department of Normal and Pathological Human Anatomy  
Kabardino-Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0002-6158-6258  
******Postgraduate student of the Department of Public Health, Health Care and Preventive Medicine Kabardino-  
Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0001-6211-4431  
*
******Postgraduate student of the Department of Public Health, Health Care and Preventive Medicine Kabardino-  
Balkarian State University named after H.M. Berbekov Nalchik, Russia. ORCID: 0000-0002-2409-0974  
Recibido: 03/02/2021  
Aceptado: 15/04/2021  
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Angela Yurievna Dolova et al.// Analysis of the structure and severity of comorbid pathology … 288-296  
DOI: http://dx.doi.org/10.46925//rdluz.33.20  
Análisis de la estructura y gravedad de la patología comórbida en  
pacientes con hipertensión arterial  
RESUMEN  
El objetivo de la investigación es estudiar la estructura y gravedad de la patología comórbida  
en pacientes hospitalizados con hipertensión arterial. Material y métodos. El estudio incluyó  
a 140 pacientes adultos (29% hombres y 71% mujeres) con hipertensión arterial y  
comorbilidad que recibían terapia en el departamento de cardiología. La edad media de los  
pacientes fue de 64,3 ± 12,0 años. Se utilizó el índice de Charlson para evaluar la comorbilidad.  
Resultados. El índice de Charlson medio en nuestro estudio fue de 3,97 ± 2,0 puntos. Se  
observó comorbilidad moderada y grave en el 77,6% de los pacientes con hipertensión arterial.  
Al analizar la frecuencia de patología concomitante, se detectó una enfermedad en el 7% de  
los examinados, dos en el 28%, tres en el 14%, cuatro en el 23%, cinco o más en el 28%. La  
estructura de la patología concomitante está representada principalmente por isquemia  
cerebral crónica (26,3%), alteraciones del ritmo y la conducción (20%), enfermedades de los  
sistemas broncopulmonar (14,8%) y digestivo (12,7%). El análisis de los factores de riesgo de  
comorbilidad reveló herencia agravada por enfermedades cardiovasculares en el 33,3% de los  
pacientes con hipertensión arterial, tabaquismo en el 7,3%, sobrepeso en el 27%, obesidad en  
el 62% y obesidad abdominal en el 87%. La obesidad no se diagnosticó en todos los hombres  
y en el 85,4% de las mujeres, lo que indica que no se tuvo en cuenta este factor de riesgo de  
comorbilidad. Conclusión. La introducción en la práctica del manejo de pacientes con  
hipertensión arterial y comorbilidad de puntuar la presencia de enfermedades concomitantes  
mediante el cálculo del índice de comorbilidad de Charlson aumentará la precisión de la  
evaluación de la predicción de su supervivencia a diez años. Identificar y corregir los  
principales factores de riesgo de comorbilidad y patología concomitante en pacientes con  
hipertensión arterial puede reducir la discapacidad y la mortalidad.  
PALABRAS CLAVE: hipertensión arterial; comorbilidad enfermedades cardiovasculares;  
Índice de Charlson; factores de riesgo.  
Introduction  
Comorbid pathology occupies one of the leading places in the clinic of internal  
diseases. According to the REKVAZA register, there was a combined cardiovascular  
pathology in outpatient practice in 79.5% of cases. On average, one patient had 2.6 diagnoses  
out of four included in the analysis. Moreover, the diagnosis of arterial hypertension was  
recorded in the outpatient card in 98.9% of patients (Boytsov et al., 2014). Arterial  
hypertension was understood as a syndrome of increased systolic blood pressure ≥140 mm  
Hg and/or diastolic blood pressure ≥90 mm Hg.  
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Angela Yurievna Dolova et al.// Analysis of the structure and severity of comorbid pathology … 288-296  
DOI: http://dx.doi.org/10.46925//rdluz.33.20  
The addition of a comorbid pathology changes the classic clinical picture of the  
underlying disease, worsens the quality of life and prognosis, increases the number of  
complications and their severity, the cost of diagnosis and treatment. Comorbid pathology  
creates new difficulties for practicing physicians, which include the selection of  
pharmacotherapy, assessment of the prognosis of all existing diseases and determination of  
patient management tactics (Comorbid pathology in clinical practice. Diagnostic and  
treatment algorithms, 2019; Comorbid pathology in clinical practice. Clinical guidelines,  
2017; Fesenko et al., 2012). Due to the lack of a generally accepted terminology for associated  
diseases, today we have chosen the term “comorbidity” and its definition, which is given by  
experts in the clinical guidelines “Comorbid pathology in clinical practice. Clinical  
guidelines” and “Comorbid pathology in clinical practice. Algorithms for diagnosis and  
treatment”. Comorbidity is understood as “a combination in one patient of two or more  
chronic diseases, etiopathogenetically interrelated with each other or coinciding in time of  
occurrence, regardless of the activity of each of them” (Comorbid pathology in clinical  
practice. Diagnostic and treatment algorithms, 2019; Comorbid pathology in clinical  
practice. Clinical guidelines, 2017). Cardiovascular comorbidity is understood as the  
presence of two or more cardiovascular diseases and pathological conditions in a patient  
(
Centers for Medicare & Medicaid Services. Chronic conditions overview, 2014). To assess  
comorbidity, the Charlson index use, which is a scoring system for assessing age and the  
presence of certain comorbidities to predict ten-year mortality of patients (Charlson et al.,  
1
994).  
However, to date, methods for assessing the severity of comorbidity have not found  
widely application in practical medicine in our country. The growing medical and social  
significance of comorbid pathology requires the study and development of new approaches  
to the diagnosis and treatment of patients with multiple diseases. Thus, a deep and versatile  
study of the structure and severity of comorbidity is of scientific and practical interest.  
The purpose of the research is to study the structure and severity of comorbid  
pathology in hospitalized patients with arterial hypertension.  
1
. Material and methods  
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DOI: http://dx.doi.org/10.46925//rdluz.33.20  
The descriptive study was carried out in the cardiology department of the State  
Budgetary Healthcare Institution "City Clinical Hospital No. 1". The study was conducted  
over 6 months from February to July 2018. The study included 140 patients (29% men and  
7
1% women). The average age of the surveyed was 64.3 ± 12.0 years (61.5 ± 14.0 years for men  
and 65.4 ± 11.0 years for women). Inclusion criteria: age over 18 years of age, diagnoses of  
arterial hypertension established in the framework of standard clinical practice,  
hospitalization in the cardiology department, the presence of comorbidity and lack of  
exclusion criteria - patient disagreement to participate in the study, patient under 18 years of  
age, patient with mentally alienating diseases.  
The research methods included a retrospective analysis of case histories and the  
formation of a database, including: complaints, life history, results of physical examination,  
laboratory and instrumental studies in accordance with current clinical guidelines and  
standards of management of patients with arterial hypertension (Chazova and Zhernakova,  
2019), clinical diagnosis. The comorbidity index was calculated for all patients. When  
calculating it, the points corresponding to certain concomitant diseases were summed up,  
and 1 point was added for every 10 years of life when the patient was over 40 years of age. The  
ten-year prognosis of mortality according to the Charlson index is usually estimated as 12%  
in the absence of comorbidity, 26% - with 1-2 points, 52% - with 3-4 points, 85% - with a  
sum of more than 5 points (Comorbid pathology in clinical practice. Diagnostic and  
treatment algorithms, 2019; Comorbid pathology in clinical practice. Clinical guidelines,  
2017). Along with this, the structure of concomitant diseases included in the clinical  
diagnosis was determined, and some risk factors for comorbidity were studied (burdened  
heredity, abdominal obesity, overweight, obesity, smoking).  
Statistical analysis of the research results was carried out using Microsoft Excel 2019.  
The analysis results are presented as the mean and its standard deviation for continuous  
variables and as a percentage (in percent) for categorical variables. The critical level of  
significance when testing statistical hypotheses was taken as p <0.05.  
2
. Research results  
The average Charlson index was 3.97 ± 2.0 points overall (3.75 ± 2.3 points for men and  
4
.0 ± 1.9 points for women). The distribution of patients with arterial hypertension according  
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REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021  
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DOI: http://dx.doi.org/10.46925//rdluz.33.20  
to the severity of comorbidity is presented in Table 1. In patients with arterial hypertension,  
moderate (55.6%) and severe (22%) degrees of comorbidity were more often observed.  
According to the methodology we used, the ten-year mortality forecast with 3-4 points on  
the Charlson index is 52%, and with a sum of more than 5 points - 85% (Comorbid pathology  
in clinical practice. Diagnostic and treatment algorithms, 2019; Comorbid pathology in  
clinical practice. Clinical guidelines, 2017; Chazova and Zhernakova, 2019).  
Table 1. The severity of comorbid pathology in patients with arterial hypertension (according  
to Charlson M.E.)  
The severity of the Charlson Index  
n (%)  
Women  
20 (20)  
58 (58)  
22 (22)  
comorbidity  
(points)  
Men  
Total  
Mild  
1-2  
8 (22,2)  
20 (55,6)  
8 (22,2)  
28 (20,6)  
78 (57,4)  
30 (22)  
Average  
Severe  
3-5  
6 and more  
The patients with arterial hypertension included in our study had from one to seven  
comorbidities (Table 2). Only 7% of those surveyed had one concomitant disease, 28% had  
two, 14% had three, 23% had four, and 28% had five or more.  
Table 2. The number of comorbidities in patients with arterial hypertension  
The number of  
Total  
Women  
Men  
comorbidities  
n
%
7
28  
14  
23  
11  
n
%
6
n
4
14  
4
6
4
%
10  
35  
10  
15  
10  
10  
10  
1
10  
38  
20  
32  
16  
10  
14  
6
24  
16  
26  
12  
6
2
3
4
5
6
7
24  
16  
26  
12  
6
7
10  
4
4
10  
10  
The structure of concomitant pathology in patients with arterial hypertension  
according to the diseases included in the clinical diagnosis is shown in Figure 1. Among  
concomitant diseases, chronic cerebral ischemia (26.3%), rhythm and conduction  
disturbances (20%), bronchopulmonary diseases (14.8 %) and digestive (12.7%) systems.  
Concomitant bronchopulmonary pathology was represented by chronic obstructive  
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DOI: http://dx.doi.org/10.46925//rdluz.33.20  
pulmonary disease (COPD, 78.6%) and bronchial asthma (21.4%). More than half of the  
arrhythmias were attributed to atrial fibrillation (57.9%). Diseases of the digestive system  
were represented by chronic pancreatitis (33.3%), gastroesophageal reflux disease (25%),  
gastric ulcer (25%) and chronic cholecystitis (16.7%).  
Structure of concomitant pathology (%)  
4%  
15%  
10%  
Diseases of the bronchopulmonary system  
Digestive system diseases  
Chronic cerebral ischemia  
Rhythm and conduction disturbances  
Varicose veins  
3
%
13%  
9
%
Diseases of the urinary system  
Diseases of the endocrine system  
Dorsopathies  
20%  
26%  
Figure 1. Structure of concomitant pathology  
Analysis of risk factors for comorbidity showed that 33.3% of patients with arterial  
hypertension have a history of cardiovascular diseases, 7.3% continue to smoke after the  
development of the disease, 15.1% have smoked in the past, 77.6% have never did not smoke.  
Of practical interest is the high prevalence of overweight in 27% of patients (45% of men and  
20% of women) and obesity in 62% of patients (55% of men and 65% of women) revealed by  
us in the analysis of the body mass index of patients with arterial hypertension. Abdominal  
obesity was detected in 87% of patients (80% of men and 89% of women). In 100% of men  
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DOI: http://dx.doi.org/10.46925//rdluz.33.20  
and 85.4% of women, obesity was not diagnosed, which indicates that this risk factor for  
comorbidity was not taken into account.  
Comparison of our results with the data of other works devoted to the study of  
cardiovascular comorbidity revealed a high prevalence of moderate and severe degrees of  
severity of comorbidity both in our study and in most others (Boytsov et al., 2014; Fesenko et  
al., 2012; Khasanova, 2020; Fortin et al., 2005; Ostroumova and Kochetkov, 2018). When  
comparing the structure of comorbid pathology, contradictory data were obtained, which is  
due to the different characteristics of the patients included in the study. At the same time,  
the features of the structure of the comorbid pathology of the patients examined by us,  
namely the prevalence of cerebrovascular diseases, COPD and diseases of the gastrointestinal  
tract, correspond to the results of most studies (Khasanova, 2020; Fortin et al., 2005;  
Ostroumova and Kochetkov, 2018; Chazova et al., 2013). In studies on the comorbidity of  
arterial hypertension and COPD, it has been demonstrated that every fourth patient with  
arterial hypertension at the age of 25 to 64 years has COPD (Ostroumova and Kochetkov,  
2018; Chazova et al., 2013). In a recent study by Kim et al. (2017), 22.9% of people with arterial  
hypertension were diagnosed with COPD, and an independent relationship was established  
between these diseases (OR 1.71, 95% CI 1.37-2.13, p <0.0001) (Kim et al., 2017).  
Conclusion  
The severity of comorbidity, assessed using the Charlson index, was 3.97 ± 2.0 points.  
In 77.6% of patients with arterial hypertension, moderate and severe comorbidity was noted.  
Analysis of the frequency of concomitant pathology in patients with arterial hypertension  
revealed one concomitant disease in 7% of the examined, two in 28%, three in 14%, four in  
23%, five or more in 28%. The structure of concomitant pathology was mainly represented  
by chronic cerebral ischemia (26.3%), rhythm and conduction disturbances (20%), diseases  
of the bronchopulmonary (14.8%) and digestive (12.7%) systems. Analysis of risk factors for  
comorbidity revealed heredity in 33.3% of patients with arterial hypertension burdened by  
cardiovascular diseases, smoking in 7.3%, overweight in 27%, obesity in 62%, abdominal  
obesity in 87%. Obesity was not diagnosed in all men and 85.4% of women, which indicates  
that this risk factor for comorbidity was not taken into account. The introduction into the  
practice of managing patients with arterial hypertension and comorbidity of scoring the  
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Angela Yurievna Dolova et al.// Analysis of the structure and severity of comorbid pathology … 288-296  
DOI: http://dx.doi.org/10.46925//rdluz.33.20  
presence of concomitant diseases by calculating the Charlson comorbidity index will  
increase the accuracy of assessing the prediction of their ten-year survival. Identifying and  
correcting the main risk factors for comorbidity and concomitant pathology in patients with  
arterial hypertension can reduce disability and mortality.  
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