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Pharmacological treatment of hypertension in COPD: A systematic review.
The hypertension and chronic obstructive pulmonary disease (COPD) syndrome is well described in the literature. Treatment for this syndrome includes the use of diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers, either in isolation or in combination. This review will focus on the potential benefits and risks of the use of these medications for hypertension in the COPD patient. The PubMed, Embase, and Cochrane Library electronic databases were searched from 1985 to June 2015 for publications that described the treatment of hypertension in COPD. Evidence from observational studies with a control group were reviewed. Six randomized controlled trials (RCTs) and 10 observational studies were identified for review. Treatment for hypertension with diuretics, beta-blockers, and ACE inhibitors in COPD patients results in blood pressure control, and reduces heart failure events. Inhaled bronchodilators may be more beneficial than oral bronchodilators, although this was based on only three RCTs, in total a small number of subjects with COPD. There was no evidence regarding the use of ARBs and calcium channel blockers in COPD. In general, the evidence was moderate for treatment of hypertension in COPD, and based on small patient numbers. There is a need for additional high quality RCTs to guide clinical practice.
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