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The Pharmacologic Treatment of Uncomplicated Arterial Hypertension in Patients With Airway Dysfunction^*

^* From the Dipartimento di Pneumologia (Drs. Cazzola, Noschese, and D’Amato), Unità Operativa Complessa di Pneumologia ed Allergologia, Ospedale A. Cardarelli, Napoli, Italy; and the Dipartimento di Medicina Sperimentale (Dr. Matera), Facoltà di Medicina e Chirurgia, Seconda Università Napoletana, Napoli, Italy

Correspondence to: Mario Cazzola, MD, FCCP, Via del Parco Margherita 24, 80121 Napoli, Italy; e-mail: mcazzola{at}qubisoft.it

Because many antihypertensive drugs can affect airway function, the treatment of hypertension in patients with airway dysfunction is complex. For example, the worsening or precipitation of asthma by ß-adrenoceptor antagonists is well-recognized, but ß₁-adrenoceptor blockers that exert mild ß₂-agonist effects, and those that modulate the endogenous production of nitric oxide, affect airway function to a lesser extent. Therapy with selective ₁-blockers is not contraindicated in cases of chronic airway obstruction. Conversely, ₂-agonists must not be given to asthmatic subjects because they can adversely affect the bronchi. Calcium channel blockers do not exert severe side effects on the airways. Angiotensin-converting enzyme inhibitors may cause cough and exacerbate or even induce asthma; however, angiotensin II type I (AT₁) antagonists do not cause cough. 5-Hydroxytryptamine modifiers such as urapidil are a treatment option for patients with chronic airway obstruction. In patients with airway dysfunction, we suggest treatment with thiazide diuretics as the initial drug choice, and calcium channel blockers if the response is poor. In the case of no response, calcium channel blockers alone must be used. However, there is no strict rule because individual patients may respond differently to individual drugs and drug combinations. Consequently, it is important to adopt a flexible approach. For patients who are unresponsive to the aforementioned drugs, AT₁ receptor antagonists, newer ß₁-adrenoceptor-blocking agents with ancillary properties (eg, celiprolol or nebivolol), and/or vasodilators can be considered.

Key Words: airway response • antihypertensive drugs • arterial hypertension • asthma • COPD

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