Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease

Abstract

Systemic hypertension and chronic obstructive pulmonary disease (COPD) frequently coexist in the same patient, especially in the elderly. Today, a wide variety of antihypertensive drugs with different mechanisms of action are available to the prescribing physician. In addition, combination drugs for hypertension are becoming increasingly popular. Certain antihypertensive drugs can affect pulmonary function. Therefore the management of such patients can present therapeutic challenges. We have examined the literature pertaining to the use of antihypertensive drugs in patients with systemic hypertension and coexisting COPD. Although data are often limited or of poor quality, we have attempted to review and then provide recommendations regarding the use of all the specific classes of antihypertensive drug therapies including combination drugs in patients with COPD. The antihypertensive agents reviewed include diuretics, aldosterone receptor blockers, beta blockers, combined alpha and beta blockers, angiotensin-converting enzyme inhibitors, angiotensin II antagonists, calcium channel blockers, alpha-1 blockers, centrally acting drugs, direct vasodilators, and combinations of these drugs. Of these classes, calcium channel blockers and angiotensin II antagonists appear to be the best initial choices if hypertension is the only indication for treatment. However, the limited data available on many of these drugs suggest that additional studies are needed to more precisely determine the best treatment choices in this widely prevalent patient group.

Lipid, blood pressure and kidney update 2013

“…However, it is worth emphasizing that we have still had very limited data on optimal BP levels in the elderly [ 110 – 113 ]. The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is an observational study of risk factors for stroke [ 114 ].…”

High positive end expiratory pressure levels affect hemodynamics in elderly patients with hypertension admitted to the intensive care unit: a prospective cohort study

“…Elderly hypertensive patients have poor cardiorespiratory function and often require ventilator assisted breathing [10]. As far as we know, the elasticity of arterial vessels in elderly patients with hypertension is diminished while the adjustment function of arterial vessels is poor; therefore, hemodynamics is susceptible to external factors such as positive pressure ventilation [11].…”

Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)—Current Considerations for Clinical Practice

“…However, there is currently no evidence for application of alternative blood pressure target values or medication when arterial hypertension is present in COPD patients. Theoretical advantages of calcium antagonists due to smooth muscle relaxation only translate into little clinical effect [88]. In recent years, several techniques for non-invasive determination of central blood pressure became available [89,90,91].…”