Treatment of arterial hypertension in patients with chronic pulmonary diseases

Abstract

This article presents a review of English-language literature pertaining to drug therapy for systemic high blood pressure in patients with pulmonary diseases. The concomitant presence of arterial hypertension and chronic airway obstruction (asthma or COPD) is not unusual. Hypertension is the most common comorbid disease in COPD patients. The antihypertensive agents reviewed include: diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, β-adrenergic blocking agents, α-blockers and other classes. A wide variety of antihypertensive drugs with different mechanism of action is now available. Many antihypertensive drugs can affect airway function, the treatment of hypertension in patients with airway dysfunction is complex. For example, β-adrenergic blocking agents can cause bronchoconstriction, because β₂-receptors are widely distributed in airway smooth muscles. Beta-blockers can cause severe bronchoconstriction even in subjects with mild asthma. Angiotensin-converting enzyme inhibitors may cause cough and excerbate or even induce asthma; however angiotensin II type I antagonists do not cause caugh. So it seems that not all antihypertensive drugs are equally safe in patients with systemic arterial hypertension and concurrent airway dysfunction. Based on the reviewed literature, we suggest that calcium blockers or angiotensin II receptor antagonists are the first choice drugs for these patients.