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The Effects of High Blood Pressure Medications on Asthma

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Updated April 09, 2014

Because high blood pressure and asthma are common diseases, it is common for patients to have both at the same time. While not unusually dangerous, this combination can present some difficult treatment challenges. Because some of the most effective and proven blood pressure medications are known to cause negative effects in people with asthma, care is required in developing effective treatment plans.

Problematic Hypertension Drugs

Among the many different drugs available for treating high blood pressure, beta blockers and ACE inhibitors have the most potential to cause problems in asthmatic patients.

Beta blockers can lead to problems because of the presence of beta receptors on respiratory passages. While blocking the action of beta receptors on blood vessels is a desired effect in treating high blood pressure (causing blood vessel dilatation), similar blockade of beta receptors on respiratory passages causes constriction, and can lead to dangerous consequences.

The beta blockers used to treat high blood pressure are not very selective, so they don’t do a good job distinguishing between the different types of receptors on blood vessels and respiratory passages. This is in contrast to the beta stimulating drugs used to treat asthma, which generally target only the receptors on respiratory passages.

Because beta blockers are so effective at treating high blood pressure, an effort has been made to develop versions that do a better job discriminating between blood vessels and respiratory passages. These drugs, called selective beta-1-blockers, have been subjected to a variety of clinical tests in order to determine their safety in asthmatic patients. These clinical tests showed that while the beta-1-blockers were safer for asthmatic patients, they still showed a tendency to constrict the respiratory passages in some people. For this reason, even these more selective drugs are rarely prescribed to people with asthma. (They are only suitable for specific types of asthma patients.)

Along with beta blockers, ACE inhibitors may present some problems for patients with asthma. One of the most common side effects of ACE inhibitors is persistent, dry cough, which occurs in up to 20% of people. Studies have shown that this cough results from a type of respiratory activity called an “asthma equivalent.” The term asthma equivalent means that the activity inside the respiratory passages mimics the effects of asthma. While serious reactions to ACE inhibitors are rare in people with asthma, they have been reported. For these reasons, ACE inhibitors are usually not considered as a “first line” (initial) drug of choice, though they may still be used as long as the prescribing doctor carefully monitors their effects.

Safe Hypertension Drugs

Many drugs for treating hypertension are safe to use in patients with asthma, including:

One side effect of diuretic treatment -- in all patients, not just those with asthma –- is low potassium (hypokalemia). Though all patients treated with diuretics have some risk of developing hypokalemia, this risk is somewhat higher in patients using inhaled asthma drugs. Asthma medications have a tendency to force potassium out of the blood and into cells, where it is not freely available. This tendency, combined with the potassium sapping nature of diuretics, means that asthmatic patients using these two types of drugs at the same time need to have their potassium levels monitored regularly.

Calcium channel blockers and ARBs have not been shown to cause any increased or unusual risk in asthmatic patients, and these drugs are excellent treatment choices. Calcium channel blockers tend to be used first because of their longer track record and lower cost.

Other Hypertension Drugs

Some hypertension drugs are considered neither “safe” nor “unsafe” for use in people with asthma. Usually, this undefined status is because the drugs haven't been specifically studied in people with both high blood pressure and asthma. In fact, most of these drugs –- including clonidine and hydralazine –- tend to be rarely used anyway, which makes the idea of specifically investigating their use in asthma patients unattractive.

Related: Do Asthma Medications Raise Blood Pressure?

Sources:

Barnes, PJ. Clinical studies with calcium antagonists in asthma. British Journal of Clinical Pharmacology 1985; 20 Supplement 2:289S.

Boulet, LP, Milot, J, Lampron, N, et al. Pulmonary function and airway responsiveness during long-term therapy with captopril. JAMA 1989; 261:413.

Bucknall, CE, Neilly, JB, Carter, R, et al. Bronchial hyperreactivity in patients who cough after receiving angiotensin converting enzyme inhibitors. British Medical Journal 1988; 296:86.

Salpeter, SR, Ormiston, TM, Salpeter, EE. Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis. Annals of Internal Medicine 2002; 137:715.

Tanaka, H, Teramoto, S, Oashi, K, et al. Effects of candesartan on cough and bronchial hyperresponsiveness in mildly to moderately hypertensive patients with symptomatic asthma. Circulation 2001; 104:281.

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