title: 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.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep.
authors.forename: Dipak
authors.initials: D
authors.lastname: Chandy
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
keywords: COPD; antihypertensive drugs; blood pressure; hypertension; treatment
references.citation: Chest. 2013 May;143(5):1312-1320
references.pmid: 23287970
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003566
references.pmid: 16235327
references.citation: Br J Dis Chest. 1978 Oct;72(4):327-32
references.pmid: 365214
references.citation: Expert Opin Pharmacother. 2011 Aug;12(12):1835-44
references.pmid: 21517698
references.citation: JAMA. 1989 Jan 20;261(3):413-6
references.pmid: 2642559
references.citation: J Cardiovasc Pharmacol. 1990;16 Suppl 5:S36-44
references.pmid: 11527135
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Nov 23;61(46):938-43
references.pmid: 23169314
references.citation: J Clin Hypertens (Greenwich). 2012 Feb;14(2):112-20
references.pmid: 22277144
references.citation: J Hum Hypertens. 1989 Dec;3(6):419-25
references.pmid: 2575174
references.citation: Am J Respir Crit Care Med. 2013 Apr 1;187(7):715-20
references.pmid: 23328521
references.citation: J Am Coll Cardiol. 2011 May 17;57(20):2037-114
references.pmid: 21524875
references.citation: Eur Respir J. 1990 Jan;3(1):46-54
references.pmid: 2311731
references.citation: Am Heart J. 1999 Sep;138(3 Pt 1):460-7
references.pmid: 10467196
references.citation: Pol Arch Med Wewn. 2011 Jul-Aug;121(7-8):253-8
references.pmid: 21878862
references.citation: Am Rev Respir Dis. 1985 Sep;132(3):541-7
references.pmid: 2864008
references.citation: J Cardiovasc Pharmacol. 1986;8 Suppl 11:S74-7
references.pmid: 2439803
references.citation: J Hum Hypertens. 2012 Nov;26(11):641-3
references.pmid: 22513754
references.citation: J Am Soc Hypertens. 2010 Jan-Feb;4(1):42-50
references.pmid: 20374950
references.citation: Chest. 1991 Feb;99(2):315-22
references.pmid: 1989788
references.citation: JAMA. 1989 Aug 18;262(7):914-9
references.pmid: 2754791
references.citation: Eur Respir J. 2006 May;27(5):972-9
references.pmid: 16446313
references.citation: Am J Med. 1989 Jun;86(6 Pt 1):653-7
references.pmid: 2729315
references.citation: Ann Intern Med. 2002 Nov 5;137(9):715-25
references.pmid: 12416945
references.citation: Hypertension. 2011 Jun;57(6):1069-75
references.pmid: 21536989
references.citation: QJM. 2005 Jul;98(7):493-7
references.pmid: 15955798
references.citation: Circulation. 2001 Jul 17;104(3):281-5
references.pmid: 11457745
references.citation: Arch Med Sci. 2011 Dec 31;7(6):1055-66
references.pmid: 22328891
references.citation: Hypertension. 1995 Mar;25(3):305-13
references.pmid: 7875754
references.citation: Blood Press. 2012 Feb;21(1):3-5
references.pmid: 21991999
references.citation: Br J Clin Pharmacol. 1988 Dec;26(6):703-8
references.pmid: 2907408
references.citation: Can Med Assoc J. 1977 Oct 22;117(8):900-3
references.pmid: 21028
references.citation: MMWR Surveill Summ. 2002 Aug 2;51(6):1-16
references.pmid: 12198919
references.citation: Am Rev Respir Dis. 1984 Oct;130(4):612-6
references.pmid: 6091508
references.citation: Arch Med Sci. 2012 Dec 20;8(6):957-69
references.pmid: 23319967
references.citation: Am Heart J. 1983 Feb;105(2):311-5
references.pmid: 6823813
references.citation: Am J Respir Crit Care Med. 2008 Oct 1;178(7):695-700
references.pmid: 18565952
references.citation: N Engl J Med. 1998 Aug 20;339(8):489-97
references.pmid: 9709041
references.citation: J Am Coll Cardiol. 2006 Jun 20;47(12):2554-60
references.pmid: 16781387
references.citation: Hypertension. 2003 Dec;42(6):1206-52
references.pmid: 14656957
references.citation: Curr Vasc Pharmacol. 2010 Nov;8(6):747-52
references.pmid: 20626340
references.citation: J Am Coll Cardiol. 2004 Aug 4;44(3):497-502
references.pmid: 15358010
references.citation: Br J Clin Pharmacol. 1976 Dec;3(6):1007-14
references.pmid: 22216522
references.citation: JAMA. 2010 May 26;303(20):2043-50
references.pmid: 20501926
references.citation: J Heart Lung Transplant. 2002 Dec;21(12):1290-5
references.pmid: 12490274
references.citation: Hypertension. 2007 Apr;49(4):839-45
references.pmid: 17309946
references.citation: Am Rev Respir Dis. 1986 Aug;134(2):262-5
references.pmid: 3740651
references.citation: Br Med J (Clin Res Ed). 1988 Jan 9;296(6615):86-8
references.pmid: 2827838
references.citation: Am Rev Respir Dis. 1989 Sep;140(3 Pt 2):S56-63
references.pmid: 2782761
references.citation: J Cardiovasc Pharmacol. 1999 Mar;33(3):461-72
references.pmid: 10069683
references.citation: N Engl J Med. 2008 May 1;358(18):1887-98
references.pmid: 18378519
references.citation: Respir Res. 2009 Jun 03;10:45
references.pmid: 19493329
references.citation: Lancet. 2000 Jul 29;356(9227):366-72
references.pmid: 10972368
references.citation: Chest. 1983 Mar;83(3):457-60
references.pmid: 6337786
references.citation: J Am Coll Cardiol. 2010 Apr 27;55(17):1780-7
references.pmid: 20413026
references.citation: Eur J Clin Pharmacol. 1986;31(2):143-7
references.pmid: 2879733
references.citation: Am J Ther. 2014 Sep-Oct;21(5):436-7
references.pmid: 21768867
references.citation: J Allergy Clin Immunol. 1987 Jun;79(6):959-63
references.pmid: 3294978
references.citation: Eur Respir J. 2008 Apr;31(4):905-6
references.pmid: 18378787
references.citation: Lancet. 1990 Dec 8;336(8728):1396-9
references.pmid: 1978872
references.citation: Curr Opin Pharmacol. 2011 Jun;11(3):204-10
references.pmid: 21450522
references.citation: Arch Intern Med. 2010 May 24;170(10):880-7
references.pmid: 20498416
references.citation: Curr Vasc Pharmacol. 2010 Nov;8(6):733-41
references.pmid: 20626337
references.citation: Ther Adv Cardiovasc Dis. 2009 Aug;3(4):329-34
references.pmid: 19638367
references.citation: Pharmacology. 1985;31(5):278-83
references.pmid: 2999840
references.citation: Arch Med Sci. 2012 Sep 8;8(4):589-97
references.pmid: 23056066
references.citation: Clin Sci (Lond). 2012 Oct;123(8):487-98
references.pmid: 22757959
references.citation: Drugs Aging. 2008;25(2):131-44
references.pmid: 18257600
references.citation: JAMA. 2002 Dec 18;288(23):3039-42
references.pmid: 12479770
references.citation: Ann Intern Med. 1992 Aug 1;117(3):234-42
references.pmid: 1616218
references.citation: Hosp Pract (1995). 2010 Feb;38(1):53-61
references.pmid: 20469625
references.citation: Thorax. 2003 Jul;58(7):629-31
references.pmid: 12832683
references.citation: Am J Med. 1987 Nov;83(5):886-92
references.pmid: 3674095
references.citation: Cochrane Database Syst Rev. 2012 Nov 14;11:CD008167
references.pmid: 23152254
references.citation: Circulation. 2005 Feb 1;111(4):420-7
references.pmid: 15687129
references.citation: Am J Med. 1983 Oct 17;75(4A):109-14
references.pmid: 6356897
references.citation: Hypertension. 2011 Sep;58(3):347-8
references.pmid: 21768523
references.citation: Br J Clin Pharmacol. 2002 Mar;53(3):243-9
references.pmid: 11874387
references.citation: Clin Ther. 1994 May-Jun;16(3):490-504
references.pmid: 7923316