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Feature Article

Hypertension and obstructive airways disease in the elderly

Belinda R Miller



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.

Key Points

  • 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.