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Treatment of hypertension in asthma and COPD

Authors
Steven E Weinberger, MD
Norman M Kaplan, MD
Section Editors
George L Bakris, MD
James K Stoller, MD, MS
Peter J Barnes, DM, DSc, FRCP, FRS
Deputy Editor
John P Forman, MD, MSc

INTRODUCTION

The management of hypertension in a patient with asthma or chronic obstructive pulmonary disease (COPD) is a common problem owing to the high prevalence of each condition in the adult population. It may be made difficult by the asthma-exacerbating effect of some antihypertensives. As an example, beta blockers should be used with great caution or not at all in patients with chronic asthma (but not chronic obstructive pulmonary disease) or acute allergic or exercise-induced bronchospasm. The angiotensin-converting enzyme (ACE) inhibitors, among the most widely used antihypertensive drugs, can induce a bothersome cough that, although not damaging to the lungs, often can be confused with cough due to such underlying pulmonary diseases such as asthma and COPD.

BETA BLOCKERS

In patients with asthma, beta blockers can cause increased bronchial obstruction and airway reactivity, and resistance to the effects of inhaled or oral beta receptor agonists (such as albuterol or terbutaline) [1,2]. Even topical ophthalmic administration of nonselective beta blockers for the treatment of glaucoma has led to asthmatic exacerbations [3]. However, beta blockers appear to be safe in patients with COPD and indeed may reduce mortality and exacerbations [4].

The acute clinical effects of beta-1-selective beta blockers and nonselective beta blockers on pulmonary function in patients with asthma were examined in a systematic review and meta-analysis of 32 randomized trials including 1367 patients [1]. The following findings were noted:

Beta-1-selective beta blockers significantly reduced FEV1 by 7 percent and attenuated the bronchodilator response to inhaled beta-2-selective agonists by 10 percent. In addition, one in eight patients had a 20 percent or greater decrease in FEV1.

Nonselective beta blockers had more profound effects on pulmonary function: FEV1 was significantly reduced by 10 percent, and the bronchodilator response to inhaled beta-2-selective was reduced by 20 percent.

       

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Literature review current through: Nov 2016. | This topic last updated: Mon Feb 01 00:00:00 GMT 2016.
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