The relationship between gastric ulcer and duodenal ulcer with hypertension from the perspective of comorbidity
https://doi.org/10.38109/2075-082X-2026-2-35-40
Abstract
The urgency of the problem of comorbidity of peptic ulcer disease and arterial hypertension is due to their high prevalence in the population, the commonality of some pathogenetic mechanisms and the difficulties of pharmacotherapy, when treatment of one pathology can negatively affect the course of another. The combination of peptic ulcer disease and arterial hypertension poses serious diagnostic and therapeutic challenges for the clinician, requiring a comprehensive and measured approach. Numerous epidemiological studies confirm that peptic ulcer disease and arterial hypertension often occur in the same patient. This association is not random and can be explained by both common risk factors (psychosocial stress, smoking, poor diet, etc.) and direct pathophysiological interactions. The presence of hypertension in a patient with peptic ulcer disease aggravates its course, increases the risk of complications (bleeding), and the need for constant use of antihypertensive and antiplatelet drugs dictates the need for a special gastroprotective strategy. This article is devoted to a literature review of current data on pathogenetic relationships, drug interactions and optimal strategies for managing patients with this comorbidity.
About the Authors
Yu. V. Zhernakova
E.I. Chazov National Medical Research Center of Cardiology, A.L. Myasnikov Institute of Clinical Cardiology
Russian Federation
Russian Federation
Yulia V. Zhernakova, Dr. of Sci. (Med.), Scientific Secretary
15а Academician Chazov St., Moscow 121552
N. T. Khachatryan
E.I. Chazov National Medical Research Center of Cardiology, A.L. Myasnikov Institute of Clinical Cardiology
Russian Federation
Russian Federation
Narine T. Khachatryan, Cand. of Sci. (Med.), junior researcher, department of hypertension
15а Academician Chazov St., Moscow 121552
T. D. Solntseva
E.I. Chazov National Medical Research Center of Cardiology, A.L. Myasnikov Institute of Clinical Cardiology
Russian Federation
Russian Federation
Tatyana D. Solntseva, candidate of medical sciences, junior researcher, department of hypertension
15а Academician Chazov St., Moscow 121552
References
1. Hao W, Zheng C, Wang Z, Ma H. Global burden and risk factors of peptic ulcer disease between 1990 and 2021: An analysis from the global burden of disease study 2021. PLoS One. 2025 Jul 11;20(7):e0325821. https://doi.org/10.1371/journal.pone.0325821
2. Malik TF, Gnanapandithan K, Singh K. Peptic Ulcer Disease. 2023 Jun 5. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2025 Jan–. PMID: 30521213.
3. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017 Aug 5;390(10094):613-624. Epub 2017 Feb 25. PMID: 28242110. https://doi.org/10.1016/S0140-6736(16)32404-7
4. Vakil N. Peptic Ulcer Disease: A Review. JAMA. 2024 Dec 3;332(21):1832-1842. PMID: 39466269. https://doi.org/10.1001/jama.2024.19094
5. Narayanan M, Reddy KM, Marsicano E. Peptic Ulcer Disease and Helicobacter pylori infection. Mo Med. 2018 May-Jun;115(3):219-224. - PMC – PubMed
6. Ko KA, Lee DK. Nonsteroidal Anti-Inflammatory Drug-Induced Peptic Ulcer Disease. Korean J Helicobacter Up Gastrointest Res. 2025 Mar;25(1):34-41. https://doi.org/10.7704/kjhugr.2025.0004
7. Yi M, Chen S, Yi X, Zhang F, Zhou X, Zeng M, Song H. Helicobacter pylori infection process: from the molecular world to clinical treatment. Front Microbiol. 2025 Feb 27;16:1541140. https://doi.org/10.3389/fmicb.2025.1541140
8. Liang X, Huang X, Cheng Y, Wang Z, Song Y, Shu Q, Xie N. A comprehensive Mendelian randomization study highlights the relationship between psychiatric disorders and non-tumor gastrointestinal diseases. Front Genet. 2024 May 9;15:1392518. https://doi.org/10.3389/fgene.2024.1392518
9. Ma L, Li X, Zhang Y. Post-traumatic stress disorder, attention deficit and hyperactivity disorder, and 24 gastrointestinal diseases: Evidence from Mendelian randomization analysis. Medicine (Baltimore). 2025 May 16;104(20):e42423. https://doi.org/10.1097/md.0000000000042423
10. Loke SS, Li WC. Peptic Ulcer Disease Associated with Central Obesity. J Pers Med. 2022 Nov 28;12(12):1968. PMID: 36556189; PMCID: PMC9786886. https://doi.org/10.3390/jpm12121968
11. Sadeghi A, Nouri F, Taherifard E, Shahlaee MA, Dehdari Ebrahimi N. Estimates of global and regional prevalence of Helicobacter pylori infection among individuals with obesity: a systematic review and meta-analysis. Infection. 2024 Aug;52(4):1223-1234. https://doi.org/10.1007/s15010-024-02244-7
12. Al-Beltagi M, Saeed NK, Bediwy AS, El-Sawaf Y, Elbatarny A, Elbeltagi R. Exploring the gut-exercise link: A systematic review of gastrointestinal disorders in physical activity. World J Gastroenterol. 2025 Jun 14;31(22):106835. https://doi.org/10.3748/wjg.v31.i22.106835
13. Yegen BC. Lifestyle and Peptic Ulcer Disease. Curr Pharm Des. 2018;24(18):2034-2040. PMID: 29745325. https://doi.org/10.2174/1381612824666180510092303
14. Wang H, Wang Z, Yu J, Jin J. Social determinants of health and Helicobacter pylori infection prevalence: a systematic review and meta-analysis. Front Public Health. 2026 Jan 13;13:1703158. https://doi.org/10.3389/fpubh.2025.1703158
15. Chen YC, Malfertheiner P, Yu HT, Kuo CL, Chang YY, Meng FT, Wu YX, Hsiao JL, Chen MJ, Lin KP, Wu CY, Lin JT, O'Morain C, Megraud F, Lee WC, El-Omar EM, Wu MS, Liou JM. Global Prevalence of Helicobacter pylori Infection and Incidence of Gastric Cancer Between 1980 and 2022. Gastroenterology. 2024 Apr;166(4):605-619. https://doi.org/10.1053/j.gastro.2023.12.022
16. Bordin D.S., Kuznetsova E.S., Stauver E.E., Nikol'skaya K.A., Chebotareva M.V., Voynovan I.N., Neyasova N.A. Epidemiology of Helicobacter pylori infection in the Russian Federation from 1990 to 2023: a systematic review. Russian Medical Inquiry. 2024;8(5):260-267. (In Russ.) https://doi.org/10.32364/2587-6821-2024-8-5-3]
17. Federal State Statistics Service of Russia. "Healthcare in Russia – 2023." (In Russ.) https://rosstat.gov.ru/ statistics/healthcare]
18. Maev IV, Andreev DN, Samsonov AA, Cheryomushkina AS. Peptic ulcer: the current state of the problem. Meditsinskiy sovet = Medical Council. 2022;(6):100-108. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-6-100-108]
19. Chazova I.E., Chikhladze N.M., Blinova N.V., Aksenova A.V., Alekseeva T.A., Ambatiello L.G., Balanova Yu.A., Bragina A.E., Danilov N.M., Drapkina O.M., Drozdova L.Yu., Ezhov M.V., Elfimova E.M., Zhernakova Yu.V., Zhirov I.V., Kislyak O.A., Litvin A.Yu., Nebieridze D.V., Ostroumova O.D., Podzolkov V.I., Sergienko I.V., Sivakova O.A., Starodubova A.V., Stryuk R.I., Tereshchenko S.N., Trushina O.Yu., Shchelkova G.V. Clinical guidelines of the Russian Medical Society on arterial Hypertension (RSH) and the Eurasian association of Cardiologists (EaC) for the diagnosis and treatment of arterial hypertension (2024). Systemic Hypertension. 2024;21(4):5-110. (In Russ.) https://doi.org/10.38109/2075-082X-2024-4-5-109]
20. Mazdorova E.V., Asketova B.A., Ryabikov A.N., Malyutina S.K. Awareness, treatment and control of arterial hypertension in the population (Literature review). Complex Issues of Cardiovascular Diseases. 2024;13(4S):168-182. (In Russ.) https://doi.org/10.17802/2306-1278-2024-13-4S-168-182]
21. Zhou, Bin et al. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 populationrepresentative studies with 104 million participants. Lancet. 2021 Sep 11;398(10304):957-980. https://doi.org/10.1016/s0140-6736(21)01330-1
22. Global report on hypertension: the race against a silent killer. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. ISBN: 978-92-4-008106-2
23. Martínez-Montoro JI, Sancho-Marín R, Ocaña-Wilhelmi L, Arranz-Salas I, Ruiz-Campos N, García-López MJ, Tinahones FJ, Gutiérrez-Repiso C. Gastric microbiota-specific signatures in adults with obesity and Helicobacter pylori-negative gastritis. Eur J Clin Invest. 2025 Nov;55(11):e70085. https://doi.org/10.1111/eci.70085
24. Liu T, Zhao X, Cai T, Li W, Zhang M. Metabolic reprogramming in Helicobacter pylori infection: from mechanisms to therapeutics. Front Cell Infect Microbiol. 2025 Oct 13;15:1678044. https://doi. org/10.3389/fcimb.2025.1678044
25. Sun X, Yuan Y, Chen L, Ye M, Zheng L. Genetically predicted visceral adipose tissue and risk of nine nontumour gastrointestinal diseases: evidence from a Mendelian randomization study. Int J Obes (Lond). 2023 May;47(5):406-412. https://doi.org/10.1038/s41366-023-01279-4
26. Li Z, Chen H, Chen T. Genetic liability to obesity and peptic ulcer disease: a Mendelian randomization study. BMC Med Genomics. 2022 Oct 4;15(1):209. PMID: 36195910; PMCID: PMC9533532. https://doi.org/10.1186/s12920-022-01366-x
27. Chen CC, Geng JH, Wu PY, Huang JC, Hu HM, Chen SC, Kuo CH. High Obesity Indices Are Associated with Gastroesophageal Reflux Disease, but Low Obesity Indices Are Associated with Peptic Ulcer Disease in a Large Taiwanese Population Study. Obes Facts. 2024;17(5):491-501. Epub 2024 Jul 18. PMID: 39008955; PMCID: PMC11458163. https://doi.org/10.1159/000540281
28. Leone A, De la Fuente-Arrillaga C, Mas MV, Sayon-Orea C, Menichetti F, Martínez-Gonzalez MA, BesRastrollo M. Association between the consumption of ultra-processed foods and the incidence of peptic ulcer disease in the SUN project: a Spanish prospective cohort study. Eur J Nutr. 2024 Sep;63(6):2367- 2378. Epub 2024 May 29. PMID: 38809325; PMCID: PMC11377682. https://doi.org/10.1007/s00394-024- 03439-2
29. Aldoori WH, Giovannucci EL, Stampfer MJ, Rimm EB, Wing AL, Willett WC. Prospective study of diet and the risk of duodenal ulcer in men. Am J Epidemiol. 1997 Jan 1;145(1):42-50. PMID: 8982021. https://doi.org/10.1093/oxfordjournals.aje.a009030
30. Misciagna G, Cisternino AM, Freudenheim J. Diet and duodenal ulcer. Dig Liver Dis. 2000 AugSep;32(6):468-72. https://doi.org/10.1016/s1590-8658(00)80002-x. PMID: 11057920.
31. Morozov S, Isakov V, Konovalova M. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol. 2018 Jun 7;24(21):2291-2299. PMID: 29881238; PMCID: PMC5989243. https://doi.org/10.3748/wjg.v24.i21.2291
32. Mahmood T, Tenenbaum S, Niu XT, Levenson SM, Seifter E, Demetriou AA. Prevention of duodenal ulcer formation in the rat by dietary vitamin A supplementation. JPEN J Parenter Enteral Nutr. 1986 JanFeb;10(1):74-7. PMID: 3945046. https://doi.org/10.1177/014860718601000174
33. Aditi A., Graham D.Y. Vitamin C, gastritis, and gastric disease: a historical review and update. Digestive Diseases and Sciences. 2012;57(10):2504-2515. https://doi.org/10.1007/s10620-012-2203-7
34. Pal J, Sanal MG, Gopal GJ. Vitamin-C as anti-Helicobacter pylori agent: More prophylactic than curativeCritical review. Indian J Pharmacol. 2011 Nov;43(6):624-7. PMID: 22144762; PMCID: PMC3229773. https://doi.org/10.4103/0253-7613.89814
35. Fontes MAP, Marins FR, Patel TA, de Paula CA, Dos Santos Machado LR, de Sousa Lima ÉB, Ventris-Godoy AC, Viana ACR, Linhares ICS, Xavier CH, Filosa JA, Patel KP. Neurogenic Background for Emotional StressAssociated Hypertension. Curr Hypertens Rep. 2023 Jul;25(7):107-116. Epub 2023 Apr 14. PMID: 37058193; PMCID: PMC10103037. https://doi.org/10.1007/s11906-023-01235-7
36. Hasebe Y, Yokota S, Fukushi I, Takeda K, Yoshizawa M, Onimaru H, Kono Y, Sugama S, Uchiyama M, Koizumi K, Horiuchi J, Kakinuma Y, Pokorski M, Toda T, Izumizaki M, Mori Y, Sugita K, Okada Y. Persistence of poststress blood pressure elevation requires activation of astrocytes. Sci Rep. 2024 Oct 3;14(1):22984. PMID: 39363030; PMCID: PMC11450218. https://doi.org/10.1038/s41598-024-73345-4
37. Brzozowski T, Magierowska K, Magierowski M, Ptak-Belowska A, Pajdo R, Kwiecien S, Olszanecki R, Korbut R. Recent Advances in the Gastric Mucosal Protection Against Stress-induced Gastric Lesions. Importance of Renin-angiotensin Vasoactive Metabolites, Gaseous Mediators and Appetite Peptides. Curr Pharm Des. 2017;23(27):3910-3922. PMID: 28228069. https://doi.org/10.2174/1381612823666170220160222
38. Konturek PC. Physiological, immunohistochemical and molecular aspects of gastric adaptation to stress, aspirin and to H. pylori-derived gastrotoxins. J Physiol Pharmacol. 1997 Mar;48(1):3-42. PMID: 9098824.
39. Jia X, Zhang P, Meng L, Tang W, Peng F. The association between smoking exposure and endothelial function evaluated using flow-mediated dilation values: a meta-analysis. BMC Cardiovasc Disord. 2024 Jun 5;24(1):292. PMID: 38840064; PMCID: PMC11151634. https://doi.org/10.1186/s12872-024-03915-x
40. Kim TH, Jeong SH, Lee YJ, Kim DH, Kim HG, Kim JM, Cho JK, Kwag SJ, Kim JY, Ju YT, Jeong CY, Park JH. Impact of smoking and age on long-term recurrence after laparoscopic primary closure for duodenal ulcer perforation: a 5-year observational study. Ann Surg Treat Res. 2025 Aug;109(2):98-104. Epub 2025 Jul 30. PMID: 40785810; PMCID: PMC12329135. https://doi.org/10.4174/astr.2025.109.2.98
41. Masum M, Mamani DA, Howard JT. Alcohol and Binge Drinking Frequency and Hypertension: A National Cross-Sectional Study in the U.S. Am J Prev Med. 2024 Sep;67(3):380-388. Epub 2024 May 17. PMID: 38762207. https://doi.org/10.1016/j.amepre.2024.05.008
42. Bigalke JA, Greenlund IM, Solis-Montenegro TX, Durocher JJ, Joyner MJ, Carter JR. Binge Alcohol Consumption Elevates Sympathetic Transduction to Blood Pressure: A Randomized Controlled Trial. Hypertension. 2024 Oct;81(10):2140-2151. Epub 2024 Aug 9. PMID: 39119705; PMCID: PMC11410516. https://doi.org/10.1161/HYPERTENSIONAHA.124.23416
43. Kärkkäinen JM, Miilunpohja S, Rantanen T, Koskela JM, Jyrkkä J, Hartikainen J, Paajanen H. Alcohol Abuse Increases Rebleeding Risk and Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding. Dig Dis Sci. 2015 Dec;60(12):3707-15. https://doi.org/10.1007/s10620-015-3806-6
44. Gao ZY, Jiang YJ, Wang J, Li C, Zhang DL. Inhibition of angiotensin II type 1 receptor reduces oxidative stress damage to the intestinal barrier in severe acute pancreatitis. Kaohsiung J Med Sci. 2023 Aug;39(8):824- 833. https://doi.org/10.1002/kjm2.12692
45. Nakagiri A., et al. Evidence for the involvement of NADPH oxidase in ischemia/reperfusion-induced gastric damage via angiotensin II. Journal of Physiology and Pharmacology. 2010;61(2):171-179. PMID: 20436217.
46. Burmak Yu.G., Petrov Y.Y., Kazakov Yu.M., et al. The peculiarities of the changes of some cardiohemodynamic and microcirculatory indices in conditions of the comorbid course of essential hypertension. New Armenian Medical Journal. 2020;14(2):20-28. https://doi.org/10.52727/1513-8042-2020-14-2-20-28
47. Kravtsova T.Yu. Clinical and pathogenetic features of arterial hypertension combined with duodenal ulcer. Possibilities of treatment optimization. Diss. Doctor of Medicine. 2011. (In Russ.)]
48. Wang B, Yu M, Zhang R, Chen S, Xi Y, Duan G. A meta-analysis of the association between Helicobacter pylori infection and risk of atherosclerotic cardiovascular disease. Helicobacter. 2020 Dec;25(6):e12761. Epub 2020 Oct 7. PMID: 33026704. https://doi.org/10.1111/hel.12761
49. Fang Y, Xie H, Fan C. Correction: Association of hypertension with helicobacter pylori: A systematic review and meta analysis. PLoS One. 2022 Oct 24;17(10):e0276919. https://doi.org/10.1371/journal.pone.0276919. Erratum for: PLoS One. 2022 May 19;17(5):e0268686. PMID: 36279271; PMCID: PMC9591046. https://doi.org/10.1371/journal.pone.0268686
50. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102-13. Epub 2011 Apr 14. PMID: 21494041. https://doi.org/10.1159/000323958
51. Yue L, Zhang R, Chen S, Duan G. Relationship between Helicobacter pylori and Incident Hypertension as well as Blood Pressure: A Systematic Review and Meta-Analysis. Dig Dis. 2023;41(1):124-137. Epub 2022 Apr 4. PMID: 35378540. https://doi.org/10.1159/000524078
52. Abrignani MG, Zullo A, Gabrielli D, Milazzo G, De Francesco V, De Luca L, Francese M, Gatta L, Imazio M, Riccio E, Rossini R, Scotto Di Uccio F, Soncini M, Colivicchi F, Di Lenarda A, Gulizia MM, Monica F. Documento di consenso intersocietario ANMCO/AIGO: Gastroprotezione nei pazienti in terapia antiaggregante e/o anticoagulante [ANMCO/AIGO Intersocietary consensus document: Gastroprotection in patients receiving antiplatelet and/or anticoagulant drugs]. G Ital Cardiol (Rome). 2020 Mar;21(3):228-241. Italian. PMID: 32100736. https://doi.org/10.1714/3306.32772
Review
For citations:
Zhernakova Yu.V., Khachatryan N.T., Solntseva T.D. The relationship between gastric ulcer and duodenal ulcer with hypertension from the perspective of comorbidity. Systemic Hypertension. 2026;23(2):35-40. (In Russ.) https://doi.org/10.38109/2075-082X-2026-2-35-40
Views:
69
JATS XML
Email this article 