Achieving target blood pressure levels while maintaining good control of respiratory disease requires careful treatment choices, but given the range of agents available, can almost always be achieved.
- Think of obstructive airways disease in elderly patients when commencing treatment for hypertension.
- COPD should be sought in patients with other smoking related diseases.
- Smoking cessation and treatment of modifiable risk factors, including obstructive sleep apnoea, are vital for managing COPD and hypertension and for reducing cardiovascular risk.
- Thiazide diuretics, calcium channel blockers and angiotensin II receptor antagonists appear to be relatively safe in patients with airflow obstruction.
- ACE inhibitor side effects of cough and bronchospasm do not appear to be more frequent in patients with airflow obstruction, but may be more troublesome if they occur.
- Beta blockers are generally contraindicated in patients who have reversible airflow obstruction.
- Beta blockers are best avoided in patients with COPD, but cardioselective beta blockers may be considered for cautious use in mild or moderate COPD if there is a compelling indication.