Fluid and electrolyte considerations in diuretic therapy for hypertensive patients with chronic obstructive pulmonary disease.
When a patient with chronic obstructive pulmonary disease (COPD) requires medical therapy for systemic hypertension, a number of special considerations may affect the choice of antihypertensive drug and subsequent management. Thiazide diuretics have no adverse effect on airway function and are the agents of choice for initial therapy. beta-Antagonists are usually considered first-line agents in antihypertensive therapy, but even relatively cardioselective ones may increase airway resistance in patients with obstructive lung diseases, and they should be used with caution, if at all, in such patients. Although potassium-wasting diuretics are the preferred agents for treating hypertension in patients with COPD, they may worsen carbon dioxide retention in hypoventilating patients and potentiate hypokalemia in those receiving corticosteroids. In addition, beta-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassium-wasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or beta-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents.
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D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000318:Adrenergic beta-Agonists / Q000009:adverse effects; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects*; D004347:Drug Interactions; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007008:Hypokalemia / Q000139:chemically induced / Q000188:drug therapy; D008173:Lung Diseases, Obstructive / Q000150:complications*; D008275:Magnesium Deficiency / Q000139:chemically induced; D011188:Potassium / Q000627:therapeutic use; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced*
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D011188:Potassium