The frequency of hypertension and other risk factors in patients undergoing large joint arthroplasty: a real-world study

Abstract

Background. The population of patients undergoing large joints arthroplasty has a high prevalence of comorbidities, such as hypertension and other cardiovascular diseases, obesity, diabetes, chronic kidney disease, etc., that are independent risk factors for the postoperative complications, especially of the thromboembolic events.Aim. To evaluate the prevalence of hypertension and other risk factors in patients undergoing large joint arthroplasty in real-world practice.Materials and methods. The study included an unselected sample of patients (n=82) who underwent arthroplasty of large joints in December 2022 at the Clinic of Traumatology, Orthopedics and Joint Pathology of the I.M. Sechenov First Moscow State Medical University. A detailed history was collected from all patients and, if necessary, a laboratory and instrumental examination was performed to assess the presence of target organ damage.Results. Sixty-two patients (81.7%) had hypertension; among them 12.6% had no previous antihypertensive therapy. The average body mass index (BMI) was 31.3±5.2 kg/m2 confirming the high prevalence of obesity in this population. All obese patients had concomitant hypertension (n=62), and 6 people (7.3%) with a BMI over 40 kg/m2 had signs of obstructive sleep apnea syndrome. Diabetes mellitus (DM) was diagnosed in 13 people (15.9%); in all cases it was type 2 diabetes. Chronic kidney disease (CKD) stage 2-4 was diagnosed in 67 people (81.7%), and all these patients had concomitant obesity and hypertension.Conclusion. Based on the analysis of published literature and a sample of patients from real-world practice, the main population undergoing the arthroplasty of large joints include elder patients, and the vast majority of them have multiply comorbidities (obesity, hypertension, CKD) that are not only the independent risk factors for poor prognosis, but also exacerbate the other concomitant conditions and further increase the risk of complications. It is necessary to conduct large prospective studies with specific evaluation of various cohorts of patients undergoing arthroplasty of large joints including a pharmacoeconomic analysis to determine the need and scope of further examination in this population with a high risk of perioperative complications.