Medicines to lower blood pressure for asthma

The relationship between blood pressure and bronchial asthma

Bronchial asthma and hypertension do not have common prerequisites for their occurrence - different risk factors, patient populations, development mechanisms. The frequent co-occurrence of diseases has become the reason for studying the patterns of this phenomenon. Conditions have been discovered that often increase blood pressure in asthmatics:

• elderly age;
• obesity;
• decompensated asthma;
• taking medications that have side effects such as hypertension.

Features of the course of hypertension against the background of bronchial asthma is an increased risk of complications in the form of cerebral and coronary circulation disorders, cardiopulmonary failure. It is especially dangerous that in asthmatics the pressure does not decrease sufficiently at night, and during an attack, a sharp deterioration in the condition in the form of a hypertensive crisis is possible.

One of the mechanisms that explains the occurrence of hypertension in the systemic circulation is insufficient oxygen supply due to bronchospasm, which provokes the release of vasoconstrictor compounds into the blood. When asthma lasts for a long time, the arterial wall becomes damaged. This manifests itself in the form of dysfunction of the inner lining and increased vascular stiffness.

We recommend reading the article about cardiac asthma and pulmonary edema. From it you will learn about the causes and symptoms of the development of the disease, as well as about diagnosis, treatment and emergency care for the patient. And here is more information about emergency care for cardiac asthma.

Signs of increased blood pressure

You can suspect an increase in blood pressure in bronchial asthma based on the following clinical manifestations:

• intense headache, diffuse or limited to the temples and back of the head;
• noise in ears; Signs of high blood pressure
• heaviness in the head;
• dizziness;
• feeling of constant weakness;
• fast fatiguability;
• nausea;
• visual impairment;
• insomnia;
• increased heart rate;
• sweating;
• hand trembling;
• numbness of the limbs;
• pressing pain in the region of the heart.

In the most severe cases, convulsive syndrome and loss of consciousness are observed against the background of an asthma attack and crisis. This condition can develop into cerebral edema with fatal consequences for the patient. The second group of complications is associated with the possibility of developing pulmonary edema due to both cardiac and pulmonary decompensation.

Medicines for hypertension and bronchial asthma

The difficulty of treating patients with a combination of hypertension and bronchial asthma is that most medications for their treatment have side effects that worsen the course of these pathologies.

Long-term use of beta-agonists for asthma causes a sustained increase in blood pressure. For example, Berotek and Salbutamol, which are very often used by asthmatics, have a selective effect on bronchial beta receptors only in low doses. As the dose or frequency of inhalation of these aerosols increases, the receptors located in the heart muscle are also stimulated.

At the same time, the rhythm of contractions accelerates and cardiac output increases. The systolic pressure increases and the diastolic decreases. High pulse blood pressure, sharp tachycardia and the release of stress hormones during an attack lead to significant circulatory impairment.

Hormonal drugs from the group of corticosteroids, which are prescribed for severe bronchial asthma, as well as Eufillin, which leads to heart rhythm disturbances, have a negative effect on hemodynamics.

Therefore, for the treatment of hypertension in the presence of bronchial asthma, drugs of certain groups are prescribed.

The use of diuretics is preferable from the loop group - Lasix, Uregit, as well as potassium-sparing drugs - Veroshpiron and Triampur.

When prescribing antihypertensive drugs, it must be taken into account that beta blockers lead to bronchospasm. This impairs pulmonary ventilation and is manifested by difficulty breathing and increasing shortness of breath. This is especially true for drugs with non-selective action.

Cardioselective drugs in small doses with concomitant tachycardia and angina pectoris can be used in patients with asthma. The safest for this category of patients is Concor and its analogues.

A frequent complication of taking angiotensin-converting enzyme inhibitors is a persistent dry cough. Therefore, although these medications do not directly affect the tone of the bronchi, attacks of shortness of breath that turn into suffocation and respiratory failure significantly worsen the well-being of patients with asthma.

Formation of the “Pulmonary Heart”

In severe cases, asthmatics develop a symptom complex called cor pulmonale . Such patients are prone to severe contraction rhythm disturbances - bradycardia and atrioventricular block; they should not use calcium antagonists, which slow down the heart rate.

In this regard, all patients who take hormonal drugs and use aerosols to relieve asthma are recommended to monitor their pulse rate and blood pressure levels daily. If there is a steady increase or decrease in levels, you should contact your doctor to adjust your therapy.

Causes and Effects

It should be noted that for the formation of right ventricular failure with its hypertrophy and the subsequent formation of chronic pulmonary heart disease, the presence of persistent arterial hypertension is necessary.
In bronchial asthma, even in its most severe form, there is no constant increase in pressure in the pulmonary vein and artery, and therefore it is somewhat incorrect to consider this pathological mechanism as the entire etiological factor of secondary arterial hypertension in bronchial asthma. In addition to this, there are a number of very important points. When transient arterial hypertension occurs, caused by an attack of suffocation during bronchial asthma, an increase in intrathoracic pressure is crucial. This is a prognostically unfavorable phenomenon, since after some time the patient will experience pronounced swelling of the neck veins, with all the ensuing adverse consequences (by and large, the symptoms of this condition will be very similar to pulmonary embolism, because the mechanisms of development of these pathological states are very similar to each other).

Scheme of the formation of a vicious circle.

Due to an increase in intrathoracic pressure and a decrease in venous return of blood to the heart, stagnation occurs in the basin of both the inferior and superior vena cava. The only adequate help in this condition will be to relieve bronchospasm using the methods used for bronchial asthma (beta2-agonists, glucocorticoids, methylxanthines) and massive hemodilution (infusion therapy).

From all of the above, it becomes clear that hypertension is not a consequence of bronchial asthma as such, for the simple reason that the resulting increase in pressure in the pulmonary circulation is not permanent and does not lead to the development of chronic pulmonary heart disease.

Another question is other chronic diseases of the respiratory system that cause persistent hypertension in the pulmonary circulation. First of all, these include chronic obstructive pulmonary disease (COPD), many other diseases affecting the lung parenchyma, such as scleroderma or sarcoidosis. In this case, yes, their participation in the occurrence of arterial hypertension is completely justified.

An important point is damage to heart tissue due to oxygen starvation, which occurs during an attack of bronchial asthma. In the future, this may play a role in increasing pressure (persistent), however, the contribution of this process will be very, very insignificant.

In a small number of people suffering from bronchial asthma (about twelve percent), a secondary increase in blood pressure occurs, which, one way or another, is associated with a violation of the formation of polyunsaturated arachidonic acid, associated with an excessive release of thromboxane-A2, some prostaglandins and leukotrienes into the blood.

This phenomenon is caused, again, by a decrease in the supply of oxygen to the patient’s blood. However, a more significant reason is the long-term use of sympathomimetics and corticosteroids. Fenoterol and salbutamol have an extremely negative effect on the state of the cardiovascular system in bronchial asthma, because in large dosages they significantly affect not only beta2-adrenergic receptors, but are also capable of stimulating beta1-adrenergic receptors, significantly increasing the heart rate (causing persistent tachycardia) , thereby increasing the myocardial oxygen demand, increasing the already severe hypoxia.

Methylxanthines (theophylline) also have a negative effect on the functioning of the cardiovascular system. With constant use, these drugs can lead to severe arrhythmia, and as a result, to disruption of the heart and resulting arterial hypertension.

Systemically used glucocorticoids (especially those used systemically) also have an extremely bad effect on the condition of blood vessels - due to their side effect, vasoconstriction.

Tactics for managing patients with bronchial asthma, which will reduce the risk of developing such complications in the future.

The most important thing is to consistently adhere to the course of treatment prescribed by a pulmonologist for bronchial asthma and avoid contact with the allergen. After all, the treatment of bronchial asthma is carried out according to the Gene protocol, developed by the world's leading pulmonologists. It is there that a rational step-by-step therapy for this disease is proposed.

That is, during the first stage of this process, attacks are observed very rarely, no more than once a week, and they are stopped with a one-time dose of Ventolin (salbutamol). By and large, provided that the patient adheres to the course of treatment and leads a healthy lifestyle, excludes contact with the allergen, the disease will not progress.

No hypertension will develop from such doses of ventolin. But our patients, for the most part, are irresponsible people and do not adhere to treatment, which leads to the need to increase the dosage of drugs, the need to add other groups of drugs to the treatment regimen with much more pronounced side effects due to the progression of the disease. This all then turns into increased blood pressure, even in children and adolescents.

It is worth noting the fact that the treatment of this kind of arterial hypertension is many times more difficult than the treatment of classical essential hypertension, due to the fact that it is impossible to use very many effective drugs. The same beta blockers (let's take the latest - nebivolol, metoprolol) - despite all their highly selectivity, still have an effect on receptors located in the lungs and may well lead to status asthmaticus (silent lung), in which ventolin is no longer will help, due to the lack of sensitivity to it.

X-ray of a patient with severe pulmonary hypertension. The numbers indicate areas of ischemia.

What it is

This is an acute pathological condition that is life-threatening and requires extremely urgent care and immediate hospitalization. The main characteristics of the disease are characterized by acute lack of air, severe suffocation and death of the patient if resuscitation measures are not provided.

At this moment, the capillaries are actively filled with blood and fluid quickly passes through the walls of the capillaries into the alveoli, where so much of it collects that it greatly impedes the supply of oxygen. In the respiratory organs, gas exchange is disrupted, tissue cells experience acute oxygen deficiency (hypoxia), and the person suffocates. Choking often occurs at night while sleeping.

The causes and types of pathology are closely related and are divided into two basic groups.

In these conditions, the alveoli become very thin, their permeability increases, their integrity is compromised, and the risk of them filling with fluid increases.

At-risk groups

Since the pathogenesis (development) of pathology is closely related to concomitant internal diseases, patients with diseases or factors that provoke such a health and life-threatening condition are at risk.

The risk group includes patients suffering from:

• disorders of the vascular system, heart;
• damage to the heart muscle due to hypertension;
• congenital heart defects, respiratory system;
• complex traumatic brain injuries, cerebral hemorrhages of various origins;
• meningitis, encephalitis;
• cancerous and benign neoplasms in brain tissue.
• pneumonia, emphysema, bronchial asthma;
• deep vein thrombosis and increased blood viscosity; there is a high probability of a floating (floating) clot breaking off from the arterial wall with penetration into the pulmonary artery, which is blocked by a thrombus, which causes thromboembolism.

What antihypertensive drugs can cause a dry cough?

Dry cough is a side effect of antihypertensive drugs from the group of angiotensin-converting enzyme inhibitors. It occurs especially often when using tablets:

• first generation - Enap, Captopril;
• constantly and in large doses;
• in patients with hypersensitivity to allergens;
• in old age;
• against the background of chronic bronchitis, bronchial asthma;
• in smokers.

A hereditary predisposition to such a reaction has also been established. Cough does not cause complications, but significantly worsens the quality of life of patients and forces them to take drugs to suppress it. They usually don’t help much, and to get rid of it you need to change the medicine. In this case, it would be best to switch to another group.

Drugs of choice

What antihypertensive drugs can still be used for bronchial asthma?

First-line drugs include calcium antagonists. They are divided into non- and dihydropidine. The first group includes Verapamil and Diltiazem, which are used less frequently in asthmatics in the presence of concomitant congestive heart failure, due to their ability to increase the heart rate.

Blood pressure tablets for asthmatics

Tablets for asthmatics to lower blood pressure should not narrow the lumen of the bronchi; for this purpose they are chosen from the following groups:

Contraindicated medications include non-selective beta-blockers (for example, Anaprilin), as they cause bronchospasm. Drugs with a selective effect (Concor) can be used after a heart attack in a small dosage.

Angiotensin-converting enzyme inhibitors are not prescribed, as they provoke coughing and worsen the course of bronchial asthma. Diuretics are acceptable, but their effectiveness in patients with asthmatic conditions is low; it is best to use them in combination with calcium antagonists (Arifam).

Unwanted drugs

As already mentioned, bronchial asthma can progress against the background of some incorrectly selected antihypertensive drugs.

• Beta blockers. A group of medications that increases bronchial obstruction, airway reactivity and reduces the therapeutic effect of sympathomimetics. Thus, the drugs aggravate the course of bronchial asthma. Currently, it is allowed to use selective beta-blockers (Atenolol, Tenoric) in small doses, but only strictly according to the indications.
• Some diuretics. In asthmatics, this group of drugs can cause hypokalemia, which leads to the progression of respiratory failure. It is worth noting that the combined use of diuretics with beta-2 agonists and systemic glucocorticosteroids only increases unwanted potassium excretion. Also, this group of drugs can increase blood thickening and cause metabolic alkalosis, as a result of which the respiratory center is depressed and gas exchange rates worsen.
• ACEI. The action of these medications causes changes in the metabolism of bradykinin and increases the content of anti-inflammatory substances in the lung parenchyma (substance P, neurokinin A). This leads to bronchoconstriction and cough. Despite the fact that this is not an absolute contraindication to the prescription of ACE inhibitors, preference in treatment is still given to another group of medications.

Another group of drugs that must be used with caution are alpha-blockers (Physiotens, Ebrantil). According to studies, they can increase the sensitivity of the bronchi to histamine, as well as increase shortness of breath in patients with bronchial asthma.

Which cough tablets increase blood pressure?

Cough medications that contain:

Almost all aerosol medications used by patients to treat bronchial asthma cause an increase in blood pressure.

Does Bronholitin increase blood pressure?

Broncholithin can increase blood pressure because it contains ephedrine. This component constricts blood vessels, which creates a high load on the heart. Therefore, the drug is contraindicated in:

• hypertension;
• angina pectoris;
• myocardial infarction;
• severe heart disease - myocarditis, arrhythmia, cardiomyopathy;
• thyrotoxicosis (increased thyroid function);
• widespread atherosclerosis (blockage of blood vessels in the heart, brain, limbs).

Broncholitin is contraindicated in myocarditis

(Hypertension)

According to statistics, every fifth person suffers from high blood pressure (hypertension). Hypertension increases stress on the heart and arteries and can also damage blood vessels in the eyes and kidneys. People with high blood pressure have a high risk of stroke and heart attack.

It is very difficult to get rid of hypertension with just one medicine; it is necessary to use complex treatment. First of all, you should change your lifestyle, choose blood pressure medications that suit your body, and start doing regular exercise and massage. In addition, herbal treatment, homeopathy and yoga have a good effect.

Main symptoms of hypertension

High blood pressure usually does not cause any symptoms, but if your blood pressure is quite high, you may experience the following symptoms:

Main causes of hypertension

Cough as a side effect of blood pressure pills

The development of cough can be a side effect when using blood pressure tablets from the group of angiotensin-converting enzyme inhibitors. This is due to the fact that their therapeutic effect is based on the release of substances (bradykinin) that cause bronchospasm.

Therefore, patients with long-term use of Enap, Capoten, and less often Lisinopril and Prestarium develop a dry hacking cough. This is an indication for changing the drug, since antitussives do not work on it.

If you have bronchial asthma and chronic bronchitis, it is not advisable to use drugs from this group. Since patients use medications that dilate the bronchi, they mask the cough reflex. In this case, the patient’s response to antiasthmatic drugs decreases, and their dosages need to be increased.

We recommend reading the article about adrenergic blockers for hypertension. From it you will learn about the action of adrenergic blockers, types of drugs and possible side effects from taking them. And here is more information about Enalapril for hypertension.

Hypertension and bronchial asthma have different mechanisms of development, but are often combined in one patient. This is due to the negative effect on hemodynamics of lack of oxygen during bronchospasm, as well as changes in the arterial wall in patients with obstructive pulmonary diseases.

One of the reasons for frequent hypertension in asthmatics is the use of drugs from the group of beta-adrenergic agonists and steroid hormones. The selection of medications to reduce blood pressure should be made from drugs that do not impair lung ventilation.

Pulmonology in questions and answers

Today, a pulmonologist, a doctor of the highest category at the Central District Hospital in Odintsovo, Moscow Region, answers our readers’ questions. Yuri PETROV

Pay attention to everything

I have bronchial asthma, diabetes and sometimes my blood pressure rises. The doctor said: “Drink something simple and easy for your blood pressure.” I bought Adelfan, and after two and a half hours I began to choke. Can this medicine cause an asthma attack? What else should I not take for blood pressure?

V. D o lgikh, Moscow region.

IF you suffer from bronchial asthma and your blood pressure often rises, you need to pay attention to at what point it rises, whether it is constantly elevated or whether it occurs against the background of an exacerbation of bronchial asthma. If an increase in blood pressure is clearly associated with an exacerbation of bronchial asthma, first of all it is necessary to treat the underlying disease - bronchial asthma, and often against the background of active treatment (after stabilization of the course of bronchial asthma) blood pressure itself tends to decrease. If your blood pressure remains high and is not clearly related to exacerbation of bronchial asthma, then you need to engage in comprehensive treatment of hypertension.

You took, in particular, the antihypertensive drug Adelfan to lower your blood pressure. But if you experience an attack of suffocation after taking Adelfan, then you should under no circumstances take this drug. For the treatment of hypertension, there are also other drugs that are good in reducing and normalizing blood pressure and at the same time do not aggravate bronchial asthma. Among them are enam, enap, captopril and others. In the treatment of hypertension, in addition to the use of the above-mentioned drugs, it is also necessary to use diuretics. For a person suffering from hypertension with frequent increases in blood pressure, it is important to remember that he needs to consume salty, smoked, peppered foods and sweet foods as little as possible, and limit fluid intake (it is advisable to consume no more than 1–1.5 liters per day) .

Much depends on shortness of breath

Sometimes I have attacks of shortness of breath, and then I can’t do anything, it feels like in the mountains when there is not enough oxygen. But the doctor doesn’t give me any diagnoses - my heart is normal, I don’t have asthma. What could it be?

K. Kh. O s i p o v, Kostroma region.

IF attacks of shortness of breath occur that periodically bother you, you must first of all pay attention to what precedes the onset of shortness of breath, whether there is any psycho-emotional arousal or physical stress! If you have difficulty inhaling and especially exhaling, then for this you need to conduct a study of the function of external respiration during the period of shortness of breath. To identify hidden bronchospasm, it is advisable to include a pharmacotest when conducting the above-mentioned study. That is, first a spirographic study is carried out, then the patient is allowed to take one or two breaths from a Berotek pocket inhaler, and a spirographic study is performed again. And depending on whether there was an improvement in spirographic parameters after a pharmacological test, the question of whether the patient has bronchospasm is decided. If you have the phenomenon of bronchospasm, then it is necessary to differentiate your disease - it is chronic obstructive bronchitis or bronchial asthma. And after this it is necessary to begin complex treatment.

Not treatment, but first aid

After an asthmatic attack, my daughter (she is 14 years old) was prescribed salbutamol in an aerosol. But friends who suffer from asthma claim that salbutamol is too strong a drug and after it no medications will have an effect on the body. Is this really true?