How Asthma Medications Affect Blood Pressure

Asthma itself is associated with high blood pressure. While hypertension medications can worsen asthma symptoms, asthma medications usually don't induce or worsen hypertension. However, there are certain risk factors that may pose some related concerns, including severe heart disease.

When asthma and hypertension occur together, the combination worsens overall health and increases the risk of death, especially if both or either condition is not well controlled. If you have asthma and hypertension, or a high risk for it, your healthcare providers will use caution when prescribing asthma medications.

Asthma Medications' Effect on Blood Pressure

Your healthcare provider will treat your asthma with the medication that is most likely to control your breathing issues.

In most cases, blood pressure isn't really a major consideration when it comes to selecting an asthma treatment, and your healthcare provider can select from the range of available asthma medications. The most common ones are corticosteroids, beta-2 agonists, leukotriene modifiers, anticholinergics, and immunomodulators.

Most of the time, medications used for treating asthma are inhaled, so they have a concentrated effect on the lungs and don't have significant systemic (throughout the body) action. The effect of asthma inhalers on blood pressure is not measurable except in certain circumstances when people have severe health risks.

Even if you develop hypertension while you are being treated for asthma, your high blood pressure is more likely primary essential hypertension (without a known cause) than a side effect of your asthma medication.

Steroids

Very high-dose corticosteroids may cause hypertension, but they don't induce high blood pressure when taken as prescribed for the treatment of asthma.

If you have asthma, steroid overdose may induce high blood pressure, however. That is one of several good reasons why you should never take more medication than prescribed. If your symptoms are not adequately managed with the dosage prescribed for you, speak with your healthcare provider.

On the other hand, oral treatments—such as corticosteroid pills—can cause systemic side effects, including hypertension, but the effect is not universal. Oral steroids have many side effects (infections, diabetes, osteoporosis, hormone dysfunction), so they are typically recommended for a short period of time rather than for chronic treatment of asthma.

Beta-2 Agonists

Beta-2 agonists include long-acting beta-2 agonists (LABAs), used for ongoing asthma management, and short-acting types (SABAs), used for acute attacks.

These medications stimulate the body's beta receptors, expanding the airways to relieve asthma symptoms. While effective for these purposes, beta-2 agonists can complicate hypertension to an extent.

Consider how hypertension medications work. They are beta-blockers, meaning they have the opposite effect of beta-agonists. High blood pressure is improved by counteracting the activity of beta receptors, not encouraging it as is the case for asthma treatment.

Blood vessels primarily have beta-1 receptors, so the increase in a beta-2 activity from these asthma drugs does not cause a substantial change in blood pressure. However, blood vessels do have some beta-2 receptors, and activating them in this way can affect blood pressure (though this is typically minimal).

Note: Some hypertension drugs are specific beta-antagonists, meaning they zero in on only the beta receptors that will help improve blood pressure. Others are non-specific drugs that counteract beta-1 receptors and beta-2 receptors, which makes them potentially harmful for people with asthma.

Special Considerations

Again, for most people, asthma medications won't negatively affect blood pressure. But the potential is there and must be considered for certain people.

Heart Disease

Asthma treatments may pose a risk for people who have a pre-existing heart condition. Research suggests that beta-2 agonists can cause blood pressure problems for people who have severe heart disease.

The reason is that beta-agonists can alter the heart rhythm in people who already have heart conduction problems (issues related to heart rate and rhythm). Any change in heart function can lead to hypertension, especially if a major cardiac event, such as a heart attack, occurs.

What this means for you is that your healthcare provider might monitor your heart rhythm for changes if you are taking a LABA and or a SABA and already have severe heart disease. If your heart disease worsens or your heart rhythm becomes irregular, your heart function can affect your blood pressure.

Pregnancy

Pregnancy can pose some asthma concerns, but for different reasons that are worth noting.

Asthma is associated with an increased risk of maternal hypertension, preeclampsia, and eclampsia. This is not correlated with asthma medication use and the cause is not fully understood. But it does highlight the importance of good asthma control during pregnancy.

Interestingly, pregnant women who have asthma and high blood pressure can experience a decreased risk of pregnancy-induced hypertension with the use of short-acting beta-agonists. But blood pressure medication, if needed, could worsen asthma symptoms.

The safest approach is to stick to your recommended asthma medicine dose and alert your healthcare provider if you are experiencing an increase in your asthma symptoms.

If your asthma worsens while you are pregnant, your healthcare provider may need to adjust your asthma treatment plan. But only they can determine what is best for both managing your asthma and your risk of hypertension exacerbation.

There is a slightly increased risk of birth malformations in babies born to women who have asthma. Research shows that this is not associated with the medication used for treating asthma, but rather the effect of asthma itself.

A Word From Verywell

Managing asthma requires taking your other medical conditions and medications into account. That's why it is so important that you list all of your illnesses and medications whenever you see a healthcare provider for any reason. You are likely to be prescribed a lower dose of asthma medication (with fewer potential side effects) if you take them as scheduled and avoid your asthma triggers as much as you can.

While asthma and hypertension often occur together, experts agree that the risk of this comorbidity could be due to issues like inflammation and genetics, and is not related to the use of asthma medication.