Bronchial asthma and arterial hypertension treatment. ACE inhibitors in bronchial asthma

In bronchial asthma, even in the most severe form, there is no constant increase in pressure in the pulmonary vein and artery, and therefore it is somewhat wrong to consider this pathological mechanism as a whole etiological factor in secondary arterial hypertension in bronchial asthma.

In addition, there are a number of very important points. With the manifestation of transient arterial hypertension caused by an asthma attack in bronchial asthma, an increase in intrathoracic pressure is of decisive importance. This is a prognostically unfavorable phenomenon, since after a while the patient will be able to observe a pronounced swelling of the cervical veins, with all the ensuing adverse consequences (by and large, the symptoms of this condition will have a lot in common with pulmonary embolism, because the mechanisms of development of these pathological states are very similar).

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 the relief of bronchospasm by the methods that are used in 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 small circle is intermittent and does not lead to the development of chronic cor pulmonale.

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 that affect the lung parenchyma, such as scleroderma or sarcoidosis. In this case, yes, their participation in the occurrence of arterial hypertension is fully justified.

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

In a small number of people with bronchial asthma (about twelve percent) there is a secondary increase in blood pressure, which, one way or another, is interconnected 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 blood to the patient. However, a more significant reason is the prolonged 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 high doses they significantly affect not only beta2-adrenergic receptors, but are also able to stimulate beta1-adrenergic receptors, significantly increasing the heart rate (causing persistent tachycardia) , thereby increasing myocardial oxygen demand, increasing the already pronounced hypoxia.

Also, methylxanthines (theophylline) have a negative effect on the functioning of the cardiovascular system. With constant use, these drugs can lead to severe arrhythmias, and as a result, to disruption of the heart and subsequent arterial hypertension.

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

The tactics of 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 against bronchial asthma and avoid contact with the allergen.
After all, the treatment of bronchial asthma is carried out according to the Jin protocol, developed by the world's leading pulmonologists. It is in it that a rational stepwise therapy of this disease is proposed.

That is, at the first stage of this process, seizures are observed very rarely, no more than once a week, and they stop with a single 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, they 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. All this then turns into an increase in 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, in view of the fact that a lot of effective drugs cannot be used. The same beta-blockers (let's take the latest - nebivolol, metoprolol) - despite all their high selectivity, they still affect the receptors located in the lungs and may well lead to status asthmaticus (silent lung), in which ventolin is no longer exactly will help, in view of the lack of sensitivity to it.

Cough as a side effect of blood pressure pills

Dry cough is a side effect of antihypertensive drugs from the group of angiotensin-converting enzyme inhibitors. It especially often occurs 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, forcing them to take drugs to suppress it. They usually do not help much, and a change of medication is necessary to get rid of it. In this case, it would be best to switch to another group.

It has been proven that pressure medications related to sartans, trade names of medicines, practically do not cause coughing:

Vasar,
Lorista,
Diocorus,
Valsacor,
Kandesar,
Micardis,
Teveten.

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

The development of cough is a side effect when using 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, in patients with prolonged use of Enap, Kapoten, less often Lisinopril and Prestarium, a dry hacking cough occurs. This is an indication for changing the drug, since antitussives do not work on it.

In the presence of bronchial asthma and chronic bronchitis, drugs of this group are undesirable to use. Since patients use medications that dilate the bronchi, they mask the cough reflex. At the same time, the patient's response to anti-asthma drugs decreases, and their dosages need to be increased.

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 oxygen deficiency during bronchospasm, as well as changes in the arterial wall in patients with obstructive pulmonary diseases.

One of the causes of frequent hypertension in asthmatics is the intake of drugs from the group of beta-agonists, steroid hormones. The selection of medications to reduce pressure should be carried out from funds that do not impair ventilation of the lungs.

Despite the fact that pulmonary hypertension still does not exist as an officially confirmed independently existing disease, an increase in blood pressure in bronchial asthma continues to haunt a huge number of patients.

Therefore, the selection of drugs should be carried out with great care.

Usually, if a patient notices an increase in blood pressure only during an asthma attack, it is enough to use only an inhaler (for example, Salbutamol) to stop both symptoms at once - suffocation and increased pressure. Specific treatment for hypertension is not required. The situation is different in a situation where the patient has persistent hypertension that is not associated with the phases of the course of bronchial asthma.

The doctor should also take into account the fact that with a long course of bronchial asthma, the patient develops a "cor pulmonale syndrome", which in practice means a change in the pharmacodynamics of certain drugs, including hypertensive ones. When prescribing a drug to combat high blood pressure, the active substance and dosage should be selected taking into account this feature of the patient's body.

Supporters of the theory of the presence of pulmonary hypertension as an independent disease insist that COPD diseases, including bronchial asthma, can cause persistent hypertension over time. Doctors attribute this to hypoxia, which haunts patients with bronchial asthma. The mechanism by which this relationship occurs is complex and involves CNS neurotransmitters, but can be summarized as follows:

The correctness of this mechanism is partly confirmed by observations of patients in clinical trials.

At the same time, when breathing stops, activation of the sympathetic system is recorded, the mechanism of action of which was described above.

In addition, as mentioned earlier, a long and severe course of bronchial asthma can provoke the development of a symptom complex known as "cor pulmonale". This phrase in practice means the inability of the right ventricle of the heart to properly perform its function.

Cor pulmonale can have different consequences depending on the neglect of the disease and the availability of adequate treatment. One of its most common symptoms is hypertension.

Another reason for the development of arterial hypertension against the background of bronchial asthma is the use of hormonal drugs to stop asthma attacks.

Glucocorticoids, administered as a tablet (oral) or injection (intramuscularly), can cause serious side effects associated with endocrine system disorders. In addition to arterial hypertension, with the frequent use of hormonal drugs for asthma, diabetes mellitus or osteoporosis can develop. However, these side effects are deprived of topical preparations produced in the form of inhalers and nebulizers.

Outcome

From all of the above, the following conclusions can be drawn:

Bronchial asthma itself can cause arterial hypertension, but this happens in a small number of patients, usually with improper treatment, accompanied by a large number of attacks of bronchial obstruction. And then, it will be an indirect effect, through trophic disorders of the myocardium.
A more serious cause of secondary hypertension would be other chronic diseases of the respiratory tract (chronic obstructive pulmonary disease (COPD), many other diseases affecting the lung parenchyma, such as scleroderma or sarcoidosis).
The main cause of the onset of hypertension in asthmatics is the drugs that treat bronchial asthma itself.
The systematic implementation by the patient of the prescribed treatment regimens and other recommendations of the attending physician is a guarantee (but not one hundred percent) that the process will not progress, and if it does, it will be much slower. This will allow you to keep the therapy at the level that was originally prescribed, not to prescribe stronger drugs, the side effects of which will not lead to the formation of arterial hypertension in the future.

How to treat hypertension in bronchial asthma?

Earlier in the article it was already said that a patient suffering from hypertension with bronchial asthma needs to monitor his condition for some time.

The doctor may even ask the patient to keep a diary, regularly recording blood pressure values, as well as the frequency and intensity of asthma attacks, medications used to relieve symptoms. Based on these data, it can be concluded whether the rise in blood pressure depends only on asthma attacks or pursues the patient constantly.

If blood pressure values exceed the norm only during and after an asthma attack, no special treatment is required. The patient should only choose the right drug, calculate the dosage and time of admission to eliminate the symptoms of asthma. If suffocation can be quickly stopped by inhalation, pressure surges can be avoided without the use of specific drugs.

Choice of drugs

If arterial hypertension is present in the patient constantly, when prescribing the drug, the doctor must solve the following problems. The drug must:

Almost all of these criteria are met by drugs whose action is based on blocking calcium channels. They reduce blood pressure in the lungs, without leading to a decrease in bronchial patency.

Among calcium antagonists, there are two main groups of drugs:

Dihydropyridine;
Non-dihydropyridine.

The main difference lies in the fact that the first group of drugs does not reduce the heart rate, and the second one does, therefore it is not used in case of congestive heart failure.

Dihydropyridine drugs:

Amlodipine;
Nifedipine;
felodipine;
Nimodipine.

The decision to use this or that drug should be made by the doctor, taking into account the patient's condition and the possible risks associated with complications from taking it. You should be especially careful when prescribing a medicine to a patient with cor pulmonale syndrome, ideally, appoint an additional consultation with a cardiologist.

The relationship of pathologies

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35% of people with respiratory diseases suffer from hypertension;
during attacks (exacerbations), the pressure rises, and during the period of remission it normalizes.

During an attack, there is an increase in blood pressure.

Arterial hypertension in bronchial asthma is treated depending on what causes it. Therefore, it is important to understand the course of the disease and what provokes it. The pressure may rise during an asthma attack. In this case, an inhaler will help to remove both symptoms, which stops the asthma attack and relieves pressure.

A suitable medicine for pressure is selected by the doctor, taking into account the possibility of the patient developing the syndrome of "cor pulmonale" - a disease in which the right heart ventricle cannot function normally. Hypertension can be provoked by the use of hormonal drugs for asthma. The doctor must track the nature of the course of the disease and prescribe the correct treatment.

Despite the fact that both diseases are pathogenetically unrelated, it has been found that blood pressure rises quite often in asthma.

Some asthmatics are at high risk of developing hypertension, namely people:

Elderly age.
With increased body weight.
With severe, uncontrolled asthma.
Taking medications that provoke hypertension.

Doctors separately distinguish secondary hypertension. Nominal this form of high blood pressure is more common among patients with bronchial asthma. This is due to the formation of chronic cor pulmonale in patients. This pathological condition develops due to hypertension in the pulmonary circulation, which, in turn, leads to hypoxic vasoconstriction.

However, bronchial asthma is rarely accompanied by a persistent increase in pressure in the pulmonary arteries and veins. That is why the option of developing secondary hypertension due to chronic cor pulmonale in asthmatics is possible only if they have a concomitant chronic lung disease (for example, obstructive disease).

Rarely, bronchial asthma leads to secondary hypertension due to disturbances in the synthesis of polyunsaturated arachidonic acid. But the most common cause of hypertension in such patients is drugs that are used for a long time to eliminate the symptoms of the underlying disease.

It is worth remembering that an asthma attack can cause a transient increase in pressure. This condition is life-threatening for the patient, because against the background of increased intrathoracic pressure and stagnation in the superior and inferior vena cava, swelling of the cervical veins and a clinical picture similar to pulmonary embolism often develop.

Such a condition, especially without prompt medical attention, can lead to death. Also, bronchial asthma, which is accompanied by high blood pressure, is dangerous for the development of disorders in the cerebral and coronary circulation or cardiopulmonary insufficiency.

Bronchial asthma is a chronic inflammation of the upper respiratory tract, which is accompanied by bronchospasm. Patients suffering from this disease often have autonomic dysfunctions. And the latter in some cases become the cause of arterial hypertension. That is why both diseases are pathogenetically related.

In addition, an increase in blood pressure is a symptom of bronchial asthma, in which the body suffers from a lack of oxygen, which in a smaller amount enters the lungs through a narrowed airway. In order to compensate for hypoxia, the cardiovascular system increases the pressure in the bloodstream, trying to provide organs and systems with the necessary amount of oxygenated blood.

Bronchial asthma and hypertension do not have common prerequisites for occurrence - different risk factors, patient population, development mechanisms. The frequent joint course of diseases has become an occasion to study the patterns of this phenomenon. Conditions have been found that often increase blood pressure in asthmatics:

elderly age;
obesity;
decompensated asthma;
taking medications that have side effects in the form.

Features of the course of hypertension against the background of bronchial asthma is an increased risk of complications in the form of disorders of cerebral and coronary circulation, cardiopulmonary insufficiency. It is especially dangerous that asthmatics do not have enough pressure at night, and during an attack, a sharp deterioration in their condition is possible.

One of the mechanisms that explains the occurrence of systemic hypertension is due to bronchospasm, which provokes the release of vasoconstrictor compounds into the blood. With a long course of asthma, the arterial wall is damaged. This manifests itself in the form of dysfunction of the inner membrane and increased stiffness of the vessels.

A suitable medicine for pressure is selected by the doctor, taking into account the possibility of the patient developing the syndrome of "cor pulmonale" - a disease in which the right heart ventricle cannot function normally. Hypertension can be provoked by the use of hormonal drugs for asthma. The doctor must track the nature of the course of the disease and prescribe the correct treatment.

These medications include sympathomimetics and corticosteroids. So, Fenoterol and Salbutamol, which are used quite often, in high doses can increase the heart rate and, accordingly, increase hypoxia by increasing myocardial oxygen demand.

In medical practice, it is not uncommon for people with a pathology of the respiratory system to experience a significant increase in blood pressure (BP) during an exacerbation of the disease.

This group includes diseases such as chronic obstructive bronchitis, bronchial asthma and emphysema. The phenomenon that causes hypertension in asthma is called pulmonogenic (pulmonary) arterial hypertension.

Many doctors deny the presence of pulmonary hypertension, insisting on the presence of two diseases that are independent of each other.

However, no less number of specialists are convinced of the direct connection between these pathologies. Their confidence is based on the following facts:

about 35% of patients with various forms of COPD suffer from hypertension;
exacerbation of the disease entails an increase in blood pressure;
the period of remission of bronchopulmonary disease is associated with the normalization of blood pressure.

Signs of increased blood pressure

In the most severe cases, against the background of an asthma attack and a crisis, there is a convulsive syndrome, loss of consciousness. 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.

Bronchial asthma is a chronic disease of the respiratory system of an infectious-allergic nature, which manifests itself in obstructive disorders of the bronchial lumen (that is, to put it more simply, in the narrowing of the airway lumen) and many cellular elements of a very different nature take part in this process, throwing out a large number of all kinds mediators - biologically active substances, which are the root cause of all these phenomena and, as a result, asthma attacks.

Chronic cor pulmonale is a pathological condition that is characterized by a number of changes in the heart itself and blood vessels (the most basic are right ventricular hypertrophy and vascular changes). This is due mainly to hypertension of the pulmonary circulation. Also, after some time, arterial hypertension of a secondary nature develops (that is, an increase in pressure, the cause of which is reliably known). The question regarding pressure in bronchial asthma, the causes of its occurrence and the consequences of this phenomenon has always been relevant.

Regarding whether these two diseases are interconnected, there are two diametrically opposed points of view.

One group of honored academicians and professors is of the opinion that one has never and will not affect the other in any way, another group of no less respected people is of the opinion that bronchial asthma is without fail the main causal factor in the development of chronic pulmonary heart, and as a result - secondary arterial hypertension. That is, according to this theory - all asthmatics in the future of hypertension.

What is most interesting, purely statistical data confirm the theory of those scientists who see bronchial asthma as the primary source of secondary arterial hypertension - with age, people with bronchial asthma experience an increase in blood pressure.

It can be argued that hypertension (aka essential hypertension) is observed with age in every first person.

An important argument in favor of this particular concept will also be the fact that chronic cor pulmonale, and as a result, secondary arterial hypertension, develops in children and adolescents suffering from bronchial asthma.

But are statistics confirmed at the level of physiology? The question is very serious, since by establishing the true etiology, pathogenesis and the relationship of this process with environmental factors, it is possible to develop an optimized treatment regimen.

The most intelligible answer on this subject was given by Professor V.K. Gavrisyuk from the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky. It is also important that this scientist is also a practicing doctor, and therefore his opinion, which is confirmed by numerous studies, may well claim not only a hypothesis, but also a theory. The essence of this teaching is given below.

In order to understand this whole problem, it is necessary to better understand the pathogenesis of the entire process. Chronic cor pulmonale develops only against the background of right ventricular failure, which, in turn, is formed due to increased pressure in the pulmonary circulation.

Hypertension of the small circle is caused by hypoxic vasoconstriction - a compensatory mechanism, the essence of which is to reduce the provision of blood flow in the ischemic lobes of the lungs and the direction of blood flow to where gas exchange is intensive (the so-called West areas).

Cause and effect

It should be noted that for the formation of right ventricular failure with its hypertrophy and the subsequent formation of chronic cor pulmonale, the presence of persistent arterial hypertension is necessary.

This is a prognostically unfavorable phenomenon, since after a while the patient will be able to observe a pronounced swelling of the cervical veins, with all the ensuing adverse consequences (by and large, the symptoms of this condition will have a lot in common with pulmonary embolism, because the mechanisms of development of these pathological states are very similar).

Scheme of the formation of a vicious circle.

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 that affect the lung parenchyma, such as scleroderma or sarcoidosis.

In this case, yes, their participation in the occurrence of arterial hypertension is fully justified.

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

All this then turns into an increase in pressure, even in children and adolescents.

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

The causes of asthma and arterial hypertension are different, risk factors, features of the course of diseases do not have common signs. But often, against the background of attacks of bronchial asthma, patients experience an increase in pressure. According to statistics, such cases are frequent, occur regularly.

Does bronchial asthma cause hypertension in patients, or are these two parallel diseases developing independently? Modern medicine has two opposing views on the issue of the relationship of pathologies.

Some doctors talk about the need to establish a separate diagnosis in asthmatics with high blood pressure - pulmonary hypertension.

Doctors point to direct causal relationships between pathologies:

35% of asthmatics develop arterial hypertension;
during an asthma attack, blood pressure rises sharply;
normalization of pressure is accompanied by an improvement in the asthmatic state (absence of attacks).

Adherents of this theory consider asthma to be the main factor in the development of chronic cor pulmonale, which causes a stable increase in pressure. According to statistics, in children with bronchial attacks, such a diagnosis occurs much more often.

The second group of doctors speaks about the absence of dependence and connection between the two diseases. Diseases develop separately from one another, but their presence affects the diagnosis, the effectiveness of treatment, and the safety of drugs.

What cough pills increase blood pressure

There are several groups of drugs used in the treatment of arterial hypertension. The doctor chooses drugs that do not harm the patient's respiratory system, so as not to complicate the course of bronchial asthma.

After all, different groups of medicines have side effects:

Beta-blockers cause tissue spasm in the bronchi, lung ventilation is disturbed, and shortness of breath increases.
ACE inhibitors (angiotensin-converting enzyme) provoke a dry cough (occurs in 20% of patients taking them), shortness of breath, aggravating the condition of asthmatics.
Diuretics cause a decrease in the level of potassium in the blood serum (hypokalemia), an increase in carbon dioxide in the blood (hypercapnia).
Alpha-blockers increase the sensitivity of the bronchi to histamine. When taken orally, they are practically safe drugs.

In complex treatment, it is important to take into account the effect of drugs that stop an asthmatic attack on the appearance of hypertension. A group of beta-agonists (Berotek, Salbutamol) with prolonged use provoke an increase in blood pressure. Doctors observe this trend after increasing the dose of inhaled aerosol. Under its influence, myocardial muscles are stimulated, which causes an increase in heart rate.

Taking hormonal drugs (Methylprednisolone, Prednisolone) causes a violation of blood flow, increases the pressure of the flow on the walls of blood vessels, which causes sharp jumps in blood pressure. Adenosinergic drugs (Aminophylline, Eufillin) lead to heart rhythm disturbance, causing an increase in pressure.

It is important that drugs that treat hypertension do not aggravate the course of bronchial asthma, and drugs to eliminate an attack do not cause an increase in blood pressure. An integrated approach will provide effective treatment. Criteria by which the doctor selects drugs for asthma from pressure:

reduced symptoms of hypertension;
lack of interaction with bronchodilators;
antioxidant characteristics;
decreased ability to form blood clots;
lack of antitussive effect;
the drug should not affect the level of calcium in the blood.

Preparations of the calcium antagonist group meet all the requirements. Studies have shown that these funds do not disrupt the respiratory system, even with regular use. Doctors use calcium channel blockers in complex therapy.

There are two groups of drugs of this action:

dihydropyridine (Felodipine, Nicardipine, Amlodipine);
non-dihydropyridine (Isoptin, Verapamil).

The drugs of the first group are more often used, they do not increase the heart rate, which is an important advantage.

Diuretics (Lasix, Uregit), cardioselective agents (Concor), a potassium-sparing group of drugs (Triampur, Veroshpiron), diuretics (Thiazid) are also used in complex therapy.

The choice of medications, their form, dosage, frequency of use and duration of use can only be carried out by a doctor. Self-treatment threatens the development of serious complications.

It is necessary to carefully select the course of treatment for asthmatics with "cor pulmonale syndrome". The doctor prescribes additional diagnostic methods in order to assess the general condition of the body.

Traditional medicine offers a wide range of methods that help reduce the frequency of asthma attacks, as well as lower blood pressure. Healing collections of herbs, tinctures, rubbing reduce pain during an exacerbation. The use of traditional medicine must also be agreed with the attending physician.

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

These include:

Beta blockers. A group of drugs that enhances bronchial obstruction, airway reactivity and reduces the therapeutic effect of sympathomimetics. Thus, 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 should be noted that the joint use of diuretics with beta-2-agonists and systemic glucocorticosteroids only enhances unwanted potassium excretion. Also, this group of drugs is able to increase blood clotting, cause metabolic alkalosis, as a result of which the respiratory center is inhibited, and gas exchange indicators deteriorate.
ACE inhibitors. The action of these drugs causes changes in the metabolism of bradykinin, increases the content of anti-inflammatory substances in the lung parenchyma (substance P, neurokinin A). This leads to bronchoconstriction and coughing. Despite the fact that this is not an absolute contraindication to the appointment of ACE inhibitors, preference in treatment is still given to another group of medications.

Another group of medicines, when using which care must be taken, is 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.

What antihypertensive drugs are still allowed to be used in bronchial asthma?

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

Dihydropyridine calcium antagonists (Nifedipine, Nicardipine, Amlodipine) are the most effective antihypertensive drugs for bronchial asthma. They expand the lumen of the artery, improve the function of its endothelium, and prevent the formation of atherosclerotic plaques in it. On the part of the respiratory system - improve the patency of the bronchi, reduce their reactivity. The best therapeutic effect was achieved when these drugs were combined with thiazide diuretics.

However, in cases where the patient has concomitant severe cardiac arrhythmias (atrioventricular block, severe bradycardia), calcium antagonists are prohibited for use.

Another group of antihypertensive drugs commonly used in asthma are angiotensin II receptor antagonists (Cozaar, Lorista). In their properties, they are similar to ACE inhibitors, however, unlike the latter, they do not affect the metabolism of bradykinin and thus do not cause such an unpleasant symptom as coughing.

Along with asthma, other diseases appear: allergies, rhinitis, diseases of the digestive tract and hypertension. Are there special pressure pills for asthmatics, and what can patients drink so as not to provoke respiratory problems? The answer to this question depends on many factors: how the seizures proceed, when they begin and what provokes them. It is important to correctly determine all the nuances of the course of diseases in order to prescribe the correct treatment and choose drugs.

The complexity of the treatment of patients with a combination of hypertension and bronchial asthma lies in the fact that most medications for their therapy have side effects that worsen the course of these pathologies.

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

This accelerates the rhythm of contractions and increases cardiac output. The diastolic rises and falls. High pulse blood pressure, a sharp release of stress hormones during an attack lead to a significant circulatory disorder.

Hormonal preparations 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 group of loop drugs - Lasix, Uregit, as well as potassium-sparing - Veroshpiron and Triampur.

When prescribing antihypertensive drugs, it should be borne in mind that beta-blockers lead to bronchospasm. This impairs pulmonary ventilation and is manifested by shortness of breath, an increase in shortness of breath. This is especially true for drugs with non-selective action.

Low-dose cardioselective agents for concomitant tachycardia and may be used in patients with asthma. The safest for this category of patients is its analogues.

A frequent complication of taking angiotensin-converting enzyme inhibitors is stubborn dryness. Therefore, although these medications do not directly affect the tone of the bronchi, but attacks of shortness of breath, turning into suffocation, respiratory failure significantly worsen the well-being of patients with asthma.

Formation of "Pulmonary heart"

In severe cases, asthmatics develop a symptom complex called cor pulmonale.
. Such patients are prone to severe dysrhythmias - and they should not use calcium antagonists that slow down the heart rate.

In this regard, all patients who take hormonal drugs and use aerosols to relieve an asthma attack are advised to monitor their pulse rate and blood pressure daily. With a steady increase or decrease in them, you need to contact your doctor to correct therapy.

Why hypertension occurs in asthma

The theory of pulmonary hypertension links the development of hypotension in bronchial asthma with a lack of oxygen (hypoxia) that occurs in asthmatics during attacks. What is the mechanism of occurrence of complications?

Lack of oxygen awakens vascular receptors, which causes an increase in the tone of the autonomic nervous system.
Neurons increase the activity of all processes in the body.
The amount of hormone produced in the adrenal glands (aldosterone) increases.
Aldosterone causes increased stimulation of the artery walls.

This process causes a sharp increase in blood pressure. The data are confirmed by clinical studies conducted during attacks of bronchial asthma.

With a long period of the disease, when asthma is treated with potent drugs, this causes disturbances in the work of the heart. The right ventricle ceases to function normally. This complication is called cor pulmonale syndrome and provokes the development of arterial hypertension.

Hormonal agents used in the treatment of bronchial asthma to help in critical condition also increase the pressure in patients. Injections with glucocorticoids or oral drugs with frequent use disrupt the endocrine system. The result is the development of hypertension, diabetes, osteoporosis.

Bronchial asthma can cause arterial hypertension by itself. The main reason for the development of hypertension are drugs used by asthmatics to relieve attacks.

There are risk factors in which an increase in pressure is more often observed in patients with asthma:

excess weight;
age (after 50 years);
development of asthma without effective treatment;
side effects of drugs.

Some risk factors can be eliminated by making lifestyle changes and following your doctor's recommendations for taking medications.

In order to start treatment of hypertension in time, asthmatics should know the symptoms of high blood pressure:

Strong headache.
Heaviness in the head.
Noise in ears.
Nausea.
General weakness.
Frequent pulse.
Palpitation.
Sweating.
Numbness of hands and feet.
Tremor.
Pain in the chest.

A particularly severe course of the disease is complicated by convulsive syndrome during an asthma attack. The patient loses consciousness, cerebral edema may develop, which can be fatal.

1 What is the relationship between diseases?
2 Types of hypertension
3 The course of the disease
4 Features of the treatment of hypertension in asthma

Principles of therapy

Hypertension and asthma should only be treated by a specialist.
Firstly, such a doctor will be able to correctly analyze the situation and refer the patient to the necessary examinations. Secondly, focusing on the results, the doctor prescribes drugs to combat hypertension and bronchial asthma.

These drugs can cause bronchial obstruction in asthmatic patients, as well as provoke airway reactivity, which blocks the therapeutic effect of inhalation and oral medications. Beta-blockers are not absolutely safe medicines, so even eye drops from this category can exacerbate asthma or hypertension.

Unfortunately, even despite the achievements of modern medicine, there is still no exact opinion, which is why the use of this group can provoke bronchospasm. Nevertheless, it is believed that in such a situation, disturbances in the parasympathetic system of the body are the main factor.

angiotensin-converting enzyme (ACE) inhibitors;

In terms of side effects, dry cough is the most common, and this symptom usually occurs due to irritation of the upper respiratory tract. According to the observations of doctors, patients with bronchial asthma more often than healthy people have such a consequence as coughing.

In addition, shortness of breath, suffocation and hypertension can be observed, respectively, asthma itself can worsen. To date, specialists rarely prescribe ACE inhibitors to patients with bronchitis, especially obstructive forms. But in fact, any disease of the respiratory system can be treated with this category of drugs, the main thing is that the doctor correctly selects the drug.

This group is great for asthmatics, but it can provoke the development of hypokalemia. Hypercapnia can also develop, which suppresses the respiratory center, which increases hypoxemia. If, with hypertension, the patient does not have pronounced swelling of the respiratory tract, then diuretics are prescribed in very small doses in order to give the maximum effect without side effects.

With arterial hypertension and asthma, patients are often prescribed nifedipine and nicardipine, which belong to the dihydropyridine group. These drugs help to relax the muscles of the tracheobronchial tree, inhibit the release of granules into the surrounding tissues, and also enhance the bronchodilator effect.

These medicines are used very carefully in the treatment of hypertension, especially when the patient has bronchial asthma. If drugs are taken orally, then no changes in bronchial patency will be observed, but instead there may be a problem with the reaction of the bronchi to histamine.

It has already been noted above that it is necessary to determine which problem is the main one - hypertension or asthma. In the previous section, attention was paid to the medical treatment of hypertension, now it's time to talk about.

In order to get rid of such a disease, the following approaches are used:

means for internal use - herbal preparations (extracts), fortified complexes, complexes with microelements, chlorophyllipt, pharmaceutical preparations;
folk medicine - herbal decoctions and tinctures;
drops and syrups for oral administration - can be represented by extracts from medicinal herbs;
means for local action - ointments, rubbing, compresses, microorganics, substances based on plant pigments, vitamins and essential oils, vegetable fats and herbal infusions;
treatment of asthmatic bronchitis is also carried out with the help of vitamin therapy - these funds can be used orally or subcutaneously;
preparations for treating the chest, there is an effect on the skin, so herbal extracts, natural oils with macro-, microelements and monovitamins, chlorophyllipt can be used;
as for external influence, you can still use a talker, which may include herbal infusions, minerals, medications, chlorophyllipt, and apply it not only to the chest, but also to the entire body, especially on the sides;
emulsions and gels - applicable for local effects on the chest, created on the basis of plant pigments and fats, herbal extracts, trace elements, vitamins A and B, monovitamins;
bronchial asthma is also successfully treated with the help of lactotherapy - these are intramuscular injections of extracts from whole cow's milk, to which aloe tree juice is added;
apipuncture - a relatively new method of treatment, helps to reduce the manifestations of not only asthma, but also hypertension;
physiotherapy - this treatment involves the use of ultrasound, UHF, electrophoresis, external laser blood irradiation, magnetotherapy, magnetic laser therapy;
pharmaceuticals - bronchodilators, antihistamines, expectorants, immunomodulators, anti-inflammatory, antitoxic, antiviral, mucolytics, antifungal and other medicines.

As you know, blood pressure in almost every person increases with age. However, for asthmatics, the presence of hypertension is a poor prognostic sign. Such patients need special attention and carefully planned drug therapy.

Doctor/nurse checking blood pressure.

Bronchial asthma and high blood pressure should be treated under the supervision of a specialist. Only a doctor can prescribe the right drugs for both diseases. After all, every drug can have side effects:

A beta-blocker can cause bronchial obstruction or bronchospasm in an asthmatic, block the effect of the use of anti-asthma drugs and inhalations.
ACE drug provokes dry cough, shortness of breath.
A diuretic can cause hypokalemia or hypercapnia.
calcium antagonists. According to studies, the drugs do not cause complications in the respiratory function.
Alpha blocker. When taken, they can provoke an incorrect reaction of the body to histamine.

Bronchial asthma is often accompanied by high blood pressure. This combination refers to an unfavorable prognostic sign of the course of both diseases. Most asthma medications worsen the course of hypertension, and reverse reactions are observed, which must be taken into account when conducting therapy.

Read in this article

The choice of medicine for hypertension in bronchial asthma depends on what provokes the development of pathology. The doctor conducts a thorough questioning of the patient in order to establish how often asthma attacks occur and when an increase in pressure is observed.

There are two scenarios for the development of events:

BP rises during an asthma attack;
pressure does not depend on seizures, constantly elevated.

The first option does not require specific treatment for hypertension. There is a need to eliminate the attack. To do this, the doctor selects an anti-asthma agent, indicates the dosage and duration of its use. In most cases, inhalation with a spray can stop an attack, reduce pressure.

If the increase in blood pressure does not depend on attacks and remission of bronchial asthma, it is necessary to choose a course of treatment for hypertension. In this case, the drugs should be as neutral as possible in terms of the presence of side effects that do not cause an exacerbation of the underlying disease of asthmatics.

Karpov Yu.A. Sorokin E.V.

RKNPK Ministry of Health of the Russian Federation, Moscow

Chronic obstructive pulmonary disease (COPD) is a chronic, slowly progressive disease. characterized by irreversible or partially reversible (with the use of bronchodilators or other treatment) obstruction of the bronchial tree. Chronic obstructive pulmonary disease is widespread among the adult population and is often combined with arterial hypertension (AH). COPD includes:

Bronchial asthma
Chronical bronchitis
emphysema
bronchiectasis

Features of the treatment of hypertension against the background of COPD are due to several factors.

1) Some antihypertensive drugs are able to increase the tone of small and medium bronchi, thereby worsening lung ventilation and aggravating hypoxemia. These agents should be avoided in COPD.

2) In persons with a long history of COPD, a symptom complex of "cor pulmonale" is formed. The pharmacodynamics of some antihypertensive drugs changes in this case, which should be taken into account during the selection and long-term treatment of hypertension.

3) Drug treatment of COPD in some cases can significantly change the effectiveness of selected antihypertensive therapy.

With a physical examination, it is difficult to make a diagnosis of cor pulmonale, since most of the signs detected during examination (pulsation of the jugular veins, systolic murmur over the tricuspid valve and increased 2nd heart sound over the pulmonic valve) are insensitive or nonspecific.

In the diagnosis of cor pulmonale, ECG, radiography, fluoroscopy, radioisotope ventriculography, myocardial scintigraphy with a thallium isotope are used, but the most informative, inexpensive and simple diagnostic method is echocardiography with Doppler scanning. Using this method, it is possible not only to identify structural changes in the parts of the heart and its valvular apparatus, but also to measure blood pressure in the pulmonary artery quite accurately. ECG signs of cor pulmonale are listed in Table 1.

What antihypertensive drugs can cause dry cough

In patients with bronchial asthma, an increase in blood pressure (BP) is often observed, and hypertension occurs.

In order to normalize the patient's condition, the doctor must carefully select pressure pills for asthma. Many drugs used to treat hypertension can cause asthma attacks.

Therapy should be carried out taking into account two diseases in order to avoid complications.

Types of drugs

Arterial hypertension, or hypertension, is one of the most common diseases of mankind, which is the main cause of myocardial infarction and stroke. To prevent the negative consequences of the disease, hypertensive patients need to constantly monitor the level of blood pressure, and in case of its increase, take the drugs prescribed by the doctor.

ACE inhibitors;
diuretics;
beta-blockers;
calcium channel blockers;
sartans.

ACE inhibitors are emergency high blood pressure pills. They are prescribed in cases of hypertensive crisis and attack, when you need to quickly normalize blood pressure and pulse rate. When ingested by a patient, ACE inhibitors prevent narrowing of venous and arterial vessels, prevent blood flow to the heart and reduce the likelihood of compaction of the heart muscle.

Diuretics are diuretic antihypertensive drugs that normalize blood pressure by increasing the water level in the body and increasing diuresis. Thanks to this, it is possible to reduce swelling in the walls of blood vessels, which allows you to increase the gaps inside them and normalize the level of pressure.

Beta-blockers are the most effective pills to combat severe hypertension. They are prescribed for people suffering from atrial fibrillation, angina pectoris, heart failure. Additionally, they are used as part of combination therapy after myocardial infarction.

Calcium channel blockers are a group of drugs intended for the complex treatment of hypertension. They are prescribed mainly to older people suffering from angina pectoris, cardiac arrhythmias and atherosclerosis.

Sartans are medicines that effectively lower blood pressure and keep it normal throughout the day. They are fast acting and do not cause severe side effects from the body. This allows them to be used for the treatment of hypertension for a long time.

Among the most famous representatives of the group of ACE inhibitors is the drug Kapoten, the main active ingredient of which is captopril. In addition to hypertension, it is prescribed for chronic heart failure, diabetic nephropathy and problems associated with the functioning of the left ventricle in the post-infarction period. Contraindications to taking the drug are:

hypersensitivity to its components;
individual intolerance to ACE inhibitors;
severe hepatic and renal pathologies;
condition after kidney transplant;
stenosis of the renal arteries;
hyperkalemia;
aortic stenosis;
pregnancy;
lactation period;
age under 18 years old.

Capoten is an effective but not safe medicine. In some patients, taking it has side effects on the body in the form of lowering blood pressure, tachycardia, dry cough, headache, diarrhea, anemia, and acidosis. In addition to Kapoten, the group of ACE inhibitors includes: Enap, Lotensin, Zokardis, Prestarium, Parnavel, Diroton, Epsitron, Irumed, Quinopril, Renitek, etc. All of these drugs have a different chemical composition, but they are equally effective at high pressure.

High blood pressure pills Hypothiazid is a time-tested diuretic, the effectiveness of which has been confirmed by many hypertensive patients. The active ingredient of the drug is hydrochlorothiazide. In medical practice, Hypothiazide is used to treat arterial hypertension and edematous syndrome, as well as to prevent the formation of stones in the urinary system. The drug should not be taken by people suffering from:

individual intolerance to its components;
hypersensitivity to sulfonamides;
progressive diabetes mellitus;
insufficient excretion of urine;
severe renal or hepatic insufficiency;
Addison's disease.

Hypothiazide is not prescribed in the first trimester of pregnancy. In the II and III trimesters, it is used when absolutely necessary. When using the drug during the lactation period, breastfeeding should be temporarily suspended. In pediatric practice, this diuretic is not prescribed for children under 3 years of age.

Taking Hypothiazid does not always work for patients without side effects. In some cases, against the background of its use, patients develop allergic reactions, pancreatitis, cholecystitis, constipation, nephritis, arrhythmia, and water and electrolyte imbalance. An increase in side effects is observed with prolonged use of the drug, so they should be treated under the supervision of a specialist.

Treatment of high blood pressure in people with concomitant cardiovascular diseases is carried out using beta-blockers. A drug belonging to this group is Atenolol, which can lower blood pressure and normalize heart rhythm. Indications for its use: hypertension, diseases accompanied by a violation of the heart rate and angina pectoris. The drug is prohibited to prescribe to patients who have:

hypersensitivity to Atenolol;
heart rate less than 40 beats / min;
vasospastic angina;
tendency to hypotension;
heart failure of chronic or acute type;
cardiogenic shock;
cardiomegaly.

The drug is not used in the treatment of children and adolescents under 18 years of age, pregnant and lactating women. The most pronounced side effects during treatment with Atenolol include: allergic reactions, lowering blood pressure, increased manifestations of heart failure, depression, nausea, vomiting, bronchospasm, insomnia, sexual dysfunction.

For elderly people who develop hypertension against the background of concomitant diseases of the cardiovascular system, complex therapy is recommended, combining the simultaneous administration of several groups of drugs. Calcium channel blockers are often used in this treatment. Amlodipine, a drug widely used in the treatment of hypertension, vasospatic angina and exertional angina, is considered to be a well-known representative of this group. The medicine is contraindicated in the following factors:

pregnancy and lactation;
under the age of 18;
individual intolerance to Amlodipine;
low blood pressure;
collapse;
unstable angina;
cardiogenic shock.

Taking Amlodipine, it should be borne in mind that it can cause undesirable consequences in the patient in the form of pain in the epigastric region, nausea, fatigue, palpitations, shortness of breath, and allergic reactions. In order for the drug treatment not to have a negative effect on the patient's well-being, it must be taken under the supervision of a specialist.

Sartans group

Some experts believe that the best blood pressure pills are sartans, which include Losartan. This drug is used in the treatment of hypertension and chronic heart failure. Contraindications to its use are:

hypersensitivity to the components of the drug;
age up to 18 years;
the period of gestation and lactation;
dehydration of the body;
severe liver pathology;
hyperkalemia.

Losartan is generally well tolerated by patients. Side effects from its use occur in approximately 5% of people and are characterized by tachycardia, nausea, diarrhea, headache, insomnia, muscle cramps, and peripheral edema. The low likelihood of developing adverse reactions allows you to take Losartan for as long as necessary.

This approach allows you to enhance the effect of the tablets and achieve a faster decrease in pressure. Before prescribing a certain remedy to a patient, the doctor carefully examines his cardiogram and test results, and also takes into account his age and general health.

Contraindicated drugs 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 a cough, 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).

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

Asthmatic and hypertensive symptoms

RKNPK Ministry of Health of the Russian Federation, Moscow

The main structural and functional features of "cor pulmonale":

Myocardial hypertrophy of the right ventricle and right atrium
Volume expansion and volume overload of the right heart
Increased systolic pressure in the right heart and pulmonary arteries
High cardiac output (early)
Atrial rhythm disturbances (extrasystole, tachycardia, less often - atrial fibrillation)
Tricuspid valve insufficiency, later pulmonic valve insufficiency
Heart failure in the systemic circulation (in the later stages).

Changes in the structural and functional properties of the myocardium in the syndrome of "cor pulmonale" often leads to "paradoxical" reactions to drugs, including those used to correct high blood pressure. In particular, one of the frequent signs of cor pulmonale are cardiac arrhythmias and conduction disorders (sinoatrial and atrioventricular blockades, tachy- and bradyarrhythmias).

b-blockers

Blockade of b 2 -adrenergic receptors causes spasm of medium and small bronchi. Deterioration of lung ventilation causes hypoxemia, and is clinically manifested by increased dyspnea and increased respiration. Nonselective b-blockers (propranolol, nadolol) block b2-adrenergic receptors, therefore, in COPD, as a rule, they are contraindicated, while cardioselective drugs (bisoprolol, betaxolol, metoprolol) can in some cases (concomitant severe angina pectoris, severe tachyarrhythmia) be prescribed in small doses under close monitoring of ECG and clinical condition (Table 2).

Bisoprolol (Concor) has the highest cardioselectivity (including in comparison with the drugs listed in Table 2) of the b-blockers used in Russia. Recent studies have shown a significant advantage of Concor in terms of safety and efficacy in chronic obstructive bronchitis compared to atenolol.

In addition, a comparison of the effectiveness of atenolol and bisoprolol in individuals with hypertension and concomitant bronchial asthma, in terms of parameters characterizing the state of the cardiovascular system (heart rate, blood pressure) and indicators of bronchial obstruction (FEV1. VC, etc.) showed the advantage of bisoprolol. In the group of patients taking bisoprolol, in addition to a significant decrease in diastolic blood pressure, there was no effect of the drug on the state of the airways, while in the placebo and atenolol group, an increase in airway resistance was detected.

b-blockers with internal sympathomimetic activity (pindolol, acebutolol) have less effect on bronchial tone, but their hypotensive effectiveness is low, and prognostic benefit in arterial hypertension has not been proven. Therefore, when combined with hypertension and COPD, their appointment is justified only according to individual indications and under strict control.

The use of b-AB with direct vasodilating properties (carvedilol) and b-AB with the properties of an inducer of endothelial nitric oxide synthesis (nebivolol) in arterial hypertension has been less studied, as well as the effect of these drugs on respiration in chronic lung diseases.

At the first symptoms of deterioration in breathing, any b-AB is canceled.

calcium antagonists

They are the "drugs of choice" in the treatment of hypertension against the background of COPD, since, along with the ability to expand the arteries of a large circle, they have the properties of bronchodilators, thereby improving lung ventilation.

Bronchodilating properties have been proven in phenylalkylamines, short- and long-acting dihydropyridines, and to a lesser extent in benzodiazepine AKs (Table 3).

However, large doses of calcium antagonists can suppress compensatory vasoconstriction of small bronchial arterioles and in these cases can disrupt the ventilation-perfusion ratio and increase hypoxemia. Therefore, if it is necessary to enhance the hypotensive effect in a patient with COPD, it is more advisable to add an antihypertensive drug of a different class (diuretic, angiotensin receptor blocker, ACE inhibitor) to the calcium antagonist, taking into account tolerability and other individual contraindications.

Angiotensin converting enzyme inhibitors and angiotensin receptor blockers

To date, there are no data on the direct effect of therapeutic doses of ACE inhibitors on lung perfusion and ventilation, despite the proven involvement of the lungs in ACE synthesis. The presence of COPD is not a specific contraindication to the use of ACE inhibitors for antihypertensive purposes. Therefore, when choosing an antihypertensive drug in patients with COPD, ACE inhibitors should be prescribed "on a general basis."

Nevertheless, it should be remembered that one of the side effects of drugs in this group is a dry cough (up to 8% of cases), which in severe cases can significantly make breathing difficult and worsen the quality of life of a patient with COPD. Very often persistent cough in such patients is a good reason for discontinuation of ACE inhibitors.

To date, there is no evidence of an adverse effect on lung function of angiotensin receptor blockers (Table 4). Therefore, their prescription for antihypertensive purposes should not depend on the presence of COPD in the patient.

Diuretics

In the long-term treatment of arterial hypertension, thiazide diuretics (hydrochlorothiazide, oxodoline) and the indole diuretic indapamide are usually used. Being in modern guidelines the "cornerstone" of antihypertensive therapy with repeatedly confirmed high preventive efficacy, thiazide diuretics do not worsen or improve the ventilation-perfusion characteristics of the pulmonary circulation - since they do not directly affect the tone of the pulmonary arterioles, small and medium bronchi.

In the long-term treatment of arterial hypertension, thiazide diuretics (hydrochlorothiazide, oxodoline) and the indole diuretic indapamide are usually used. Being in modern guidelines the "cornerstone" of antihypertensive therapy with repeatedly confirmed high preventive efficacy, thiazide diuretics do not worsen or improve the ventilation-perfusion characteristics of the pulmonary circulation - since they do not directly affect the tone of the pulmonary arterioles, small and medium bronchi.

Therefore, the presence of COPD does not limit the use of diuretics for the treatment of concomitant hypertension. With concomitant heart failure with congestion in the pulmonary circulation, diuretics become the means of choice, since they reduce elevated pressure in the pulmonary capillaries, however, in such cases, thiazide diuretics are replaced by loop diuretics (furosemide, bumetanide, ethacrynic acid)

With decompensation of chronic "cor pulmonale" with the development of circulatory failure in a large circle (hepatomegaly, swelling of the extremities), it is preferable to prescribe non-thiazide drugs. and loop diuretics (furosemide, bumetanide, ethacrynic acid). In such cases, it is necessary to regularly determine the electrolyte composition of the plasma and, if hypokalemia occurs, as a risk factor for cardiac arrhythmias, actively prescribe potassium-sparing drugs (spironolactone).

a-blockers and vasodilators

In hypertension, the direct vasodilator hydralazine, or a-blockers prazosin, doxazosin, terazosin, are sometimes prescribed. These drugs reduce peripheral vascular resistance by directly acting on arterioles. These drugs do not have a direct effect on respiratory function, and therefore, if indicated, they can be prescribed to reduce blood pressure.

However, a common side effect of vasodilators and a-blockers is reflex tachycardia, requiring the appointment of b-ABs, which, in turn, can cause bronchospasm. In addition, in the light of recent data from prospective randomized trials, the appointment of a-blockers in hypertension is now limited due to the risk of developing heart failure with long-term use.

Rauwolfia preparations

Although in most countries rauwolfia preparations have long been excluded from the official list of drugs for the treatment of hypertension, in Russia these drugs are still widely used, primarily because of their cheapness. Drugs in this group can worsen breathing in some patients with COPD (mainly due to edema of the mucous membrane of the upper respiratory tract).

Drugs of "central" action

Antihypertensive drugs in this group have a different effect on the respiratory tract, but in general, their use in concomitant COPD is considered safe. Clonidine is an a-adrenergic agonist, however, it acts mainly on the a-adrenergic receptors of the vasomotor center of the brain, so its effect on the small vessels of the mucous membrane of the respiratory tract is insignificant.

There are currently no reports of serious deterioration in breathing in COPD during treatment of hypertension with methyldopa, guanfacine, and moxonidine. However, it should be emphasized that this group of drugs is almost never used for the treatment of hypertension in most countries due to the lack of evidence for improving the prognosis and a large number of side effects.

The effect of drugs used in COPD on the effectiveness of antihypertensive therapy

As a rule, antibiotics, mucolytic and expectorant drugs prescribed to patients with COPD do not affect the effectiveness of antihypertensive therapy. The situation is somewhat different with drugs that improve bronchial patency. Inhalations of b-agonists in high doses can cause tachycardia in patients with hypertension and provoke an increase in blood pressure - up to a hypertensive crisis.

Sometimes prescribed in COPD for the relief / prevention of bronchospasm, inhaled steroid drugs usually do not affect blood pressure. In cases where long-term intake of steroid hormones by mouth is required, fluid retention, weight gain and an increase in blood pressure are likely as part of the development of Cushing's drug syndrome. In such cases, the correction of elevated blood pressure is carried out, first of all, with diuretics.

In medical practice, it is not uncommon for people with a pathology of the respiratory system to experience a significant increase in blood pressure (BP) during an exacerbation of the disease.

The pathologies of the respiratory system, which will be discussed, are collectively denoted by the abbreviation COPD - chronic obstructive pulmonary disease.

Many doctors deny the presence of pulmonary hypertension, insisting on the presence of two diseases that are independent of each other.

However, no less number of specialists are convinced of the direct connection between these pathologies. Their confidence is based on the following facts:

about 35% of patients with various forms of COPD suffer from hypertension;
exacerbation of the disease entails an increase in blood pressure;
the period of remission of bronchopulmonary disease is associated with the normalization of blood pressure.

Can bronchial asthma cause complications in the form of hypertension?

Despite the fact that pulmonary hypertension still does not exist as an officially confirmed independently existing disease, an increase in blood pressure in bronchial asthma continues to haunt a huge number of patients.

At the same time, it is necessary to treat high blood pressure with extreme caution, because. many means for normalizing pressure are ways to cause an attack of suffocation in a patient. Such tablets increase the tone of the small bronchi, and therefore their ventilation worsens.

Therefore, the selection of drugs should be carried out with great care.

The correctness of this mechanism is partly confirmed by observations of patients in clinical trials.

Patients who do not suffer from COPD, but who experience sleep apnea (periodic breathing stops due to snoring), suffer from high blood pressure in almost 90% of cases!

At the same time, when breathing stops, activation of the sympathetic system is recorded, the mechanism of action of which was described above.

Cor pulmonale can have different consequences depending on the neglect of the disease and the availability of adequate treatment. One of its most common symptoms is hypertension.

Another reason for the development of arterial hypertension against the background of bronchial asthma is the use of hormonal drugs to stop asthma attacks.

How to treat hypertension in bronchial asthma?

Earlier in the article it was already said that a patient suffering from hypertension with bronchial asthma needs to monitor his condition for some time.

Choice of drugs

If arterial hypertension is present in the patient constantly, when prescribing the drug, the doctor must solve the following problems. The drug must:

Almost all of these criteria are met by drugs whose action is based on blocking calcium channels. They reduce blood pressure in the lungs, without leading to a decrease in bronchial patency.

Among calcium antagonists, there are two main groups of drugs:

Dihydropyridine;
Non-dihydropyridine.

The main difference lies in the fact that the first group of drugs does not reduce the heart rate, and the second one does, therefore it is not used in case of congestive heart failure.

Dihydropyridine drugs:

felodipine;

Non-dihydropyridine drugs:

Verapamil;
Diltiazem.

How complicated is the treatment of asthma in hypertension?

Difficulties in the fight against asthma with concomitant hypertension are associated with the same problems as in the selection of a remedy for hypertension in asthma. It is necessary to make sure that the remedies aimed at eliminating both symptoms are compatible with each other - i.e. do not enter into a chemical reaction and do not enhance the side effects of each other. In addition, you should:

In general, with a competent and timely diagnosis of the disease and the appointment of compatible new generation drugs, the patient can live for many years without experiencing severe hypertensive and asthmatic symptoms.

At the same time, it is important to understand one's responsibility for the timely intake of drugs in the correct dosage and, if possible, to minimize the "trigger" factors that provoke asthma attacks or hypertension.

In patients with bronchial asthma, an increase in blood pressure (BP) is often observed, and hypertension occurs. In order to normalize the patient's condition, the doctor must carefully select pressure pills for asthma. Many drugs used to treat hypertension can cause asthma attacks. Therapy should be carried out taking into account two diseases in order to avoid complications.

Some doctors talk about the need to establish a separate diagnosis in asthmatics with high blood pressure - pulmonary hypertension.

Doctors point to direct causal relationships between pathologies:

35% of asthmatics develop arterial hypertension;
during an asthma attack, blood pressure rises sharply;
normalization of pressure is accompanied by an improvement in the asthmatic state (absence of attacks).

Adherents of this theory consider asthma to be the main factor in the development of chronic cor pulmonale, which causes a stable increase in pressure. According to statistics, in children with bronchial attacks, such a diagnosis occurs much more often.

Regardless of whether there is a relationship between bronchial asthma and hypertension, the presence of pathologies should be taken into account in order to choose the right course of treatment. Many blood pressure pills are contraindicated in asthma patients.

Lack of oxygen awakens vascular receptors, which causes an increase in the tone of the autonomic nervous system.
Neurons increase the activity of all processes in the body.
The amount of hormone produced in the adrenal glands (aldosterone) increases.
Aldosterone causes increased stimulation of the artery walls.

This process causes a sharp increase in blood pressure. The data are confirmed by clinical studies conducted during attacks of bronchial asthma.

Bronchial asthma can cause arterial hypertension by itself. The main reason for the development of hypertension are drugs used by asthmatics to relieve attacks.

There are risk factors in which an increase in pressure is more often observed in patients with asthma:

excess weight;
age (after 50 years);
development of asthma without effective treatment;
side effects of drugs.

Some risk factors can be eliminated by making lifestyle changes and following your doctor's recommendations for taking medications.

In order to start treatment of hypertension in time, asthmatics should know the symptoms of high blood pressure:

Strong headache.
Heaviness in the head.
Noise in ears.
Nausea.
General weakness.
Frequent pulse.
Palpitation.
Sweating.
Numbness of hands and feet.
Tremor.
Pain in the chest.

A particularly severe course of the disease is complicated by convulsive syndrome during an asthma attack. The patient loses consciousness, cerebral edema may develop, which can be fatal.

There are two scenarios for the development of events:

BP rises during an asthma attack;
pressure does not depend on seizures, constantly elevated.

The first option does not require specific treatment for hypertension. There is a need to eliminate the attack. To do this, the doctor selects an anti-asthma agent, indicates the dosage and duration of its use. In most cases, inhalation with a spray can stop an attack, reduce pressure.

After all, different groups of medicines have side effects:

Beta-blockers cause tissue spasm in the bronchi, lung ventilation is disturbed, and shortness of breath increases.
ACE inhibitors (angiotensin-converting enzyme) provoke a dry cough (occurs in 20% of patients taking them), shortness of breath, aggravating the condition of asthmatics.
Diuretics cause a decrease in the level of potassium in the blood serum (hypokalemia), an increase in carbon dioxide in the blood (hypercapnia).
Alpha-blockers increase the sensitivity of the bronchi to histamine. When taken orally, they are practically safe drugs.

Taking hormonal drugs (Methylprednisolone, Prednisolone) causes a violation of blood flow, increases the pressure of the flow on the walls of blood vessels, which causes sharp jumps in blood pressure. Adenosinergic drugs (Aminophylline, Eufillin) lead to heart rhythm disturbance, causing an increase in pressure.

Criteria by which the doctor selects drugs for asthma from pressure:

reduced symptoms of hypertension;
lack of interaction with bronchodilators;
antioxidant characteristics;
decreased ability to form blood clots;
lack of antitussive effect;
the drug should not affect the level of calcium in the blood.

There are two groups of drugs of this action:

dihydropyridine (Felodipine, Nicardipine, Amlodipine);
non-dihydropyridine (Isoptin, Verapamil).

The drugs of the first group are more often used, they do not increase the heart rate, which is an important advantage.

Diuretics (Lasix, Uregit), cardioselective agents (Concor), a potassium-sparing group of drugs (Triampur, Veroshpiron), diuretics (Thiazid) are also used in complex therapy.

The choice of medications, their form, dosage, frequency of use and duration of use can only be carried out by a doctor. Self-treatment threatens the development of serious complications.

Patients with bronchial asthma can avoid the development of arterial hypertension if they follow the doctor's recommendations regarding treatment and lifestyle:

Relieve asthma attacks with local preparations, reducing the effects of toxins on the entire body.
Conduct regular monitoring of heart rate and blood pressure.
If you experience heart rhythm disturbances or a stable increase in pressure, consult a doctor.
Do a cardiogram twice a year for the timely detection of pathologies.
Take maintenance drugs in case of chronic hypertension.
Avoid increased physical exertion, stress, provoking pressure drops.
Give up bad habits (smoking exacerbates asthma and hypertension).

Bronchial asthma is not a sentence and a direct cause of the development of arterial hypertension. A timely diagnosis, a correct course of treatment that takes into account symptoms, risk factors and side effects, and the prevention of complications will allow patients with asthma to live for many years.

Bronchial asthma with concomitant diseases of various organs- features of the clinical course of bronchial asthma in various concurrent diseases.

The most common in patients with bronchial asthma are allergic rhinitis, allergic rhinosinusopathy, vasomotor rhinitis, nasal and sinus polyposis, arterial hypertension, various endocrine disorders, pathology of the nervous and digestive systems.

The presence of arterial hypertension in patients with bronchial asthma is a generally recognized fact. The frequency of the combination of these diseases is increasing. The main factor in increasing systemic arterial pressure is central and regional hemodynamic disorders: an increase in peripheral vascular resistance, a decrease in pulse blood filling of the brain, and hemodynamic disturbances in the pulmonary circulation. Hypoxia and hypercapnia accompanying chronic bronchial obstruction, as well as the influence of vasoactive substances (serotonin, catecholamines and their precursors) contribute to an increase in blood pressure. There are two forms of arterial hypertension in bronchial asthma: hypertension (25% of patients), which proceeds benignly and slowly progresses, and symptomatic "pulmogenic" (the predominant form, 75% of patients). With the "pulmogenic" form, blood pressure rises mainly during severe bronchial obstruction (attack, exacerbation), and in some patients it does not reach the norm and increases during exacerbation (stable phase).

Bronchial asthma is often combined with endocrine disorders. There is a known correlation between asthma symptoms and female genital function. In puberty in girls and premenopausal in women, the severity of the disease increases. In women suffering from bronchial asthma, premenstrual asthmatic syndrome often occurs: exacerbation 2-7 days before the onset of menstruation, less often simultaneously with it; with the onset of menstruation comes a significant relief. There are no pronounced fluctuations in bronchial reactivity. Most patients have ovarian dysfunction.

Bronchial asthma is severe when combined with hyperthyroidism, which significantly disrupts the metabolism of glucocorticosteroids. A particularly severe course of bronchial asthma is observed against the background of Addison's disease (a rare combination). Sometimes bronchial asthma is combined with myxedema and diabetes mellitus (about 0.1% of cases).

Bronchial asthma is accompanied by CNS disorders of various nature. In the acute stage, psychotic states with psychomotor agitation, psychoses, and coma are observed. In a chronic course, vegetative dystonia is formed with changes at all levels of the autonomic nervous system. Asthenoneurotic syndrome is manifested by irritability, fatigue, sleep disturbance. Vegetative-vascular dystonia is characterized by a number of signs: hyperhidrosis of the palms and feet, red and white "dermographism", tremor, vegetative crises of the sympathoadrenal type (sudden shortness of breath with a respiratory rate of 34-38 in 1 min, a feeling of heat, tachycardia up to 100-120 in 1 min , rise in blood pressure to 150/80-190/100 mm Hg, frequent profuse urination, urge to defecate). Crises develop in isolation, imitate an asthmatic attack with a subjective feeling of suffocation, but there is no difficult exhalation and wheezing in the lungs. Symptoms of autonomic dystonia occur with the onset of bronchial asthma and become more frequent in parallel with its exacerbations. Autonomic dysfunction is manifested by weakness, dizziness, sweating, fainting, and contributes to the lengthening of the period of coughing, asthma attacks, residual symptoms, faster progression of the disease and relative resistance to therapy.

Concomitant diseases of the digestive system (pancreatic dysfunction, dysfunction of the liver, intestines), which are found in a third of patients, especially with prolonged glucocorticosteroid therapy, can have a significant impact on the course of bronchial asthma.

Concomitant diseases complicate the course of bronchial asthma, complicate its treatment and require appropriate correction. Therapy of arterial hypertension in bronchial asthma has certain features. "Pulmogenic" arterial hypertension, which is observed only during attacks of suffocation (labile phase), can normalize after the elimination of bronchial obstruction without the use of antihypertensive drugs. In cases of stable arterial hypertension, complex treatment uses hydralazine preparations, ganglioblockers (arpenal, fubromegan, merpanit, temekhin, peitamine), hypothiazide, veroshpiron (has the properties of an aldosterone blocker, corrects electrolyte disturbances) 100-150 mg per day for three weeks . Adrenergic drugs a-blocking, in particular pyrroxane, can be effective, calcium antagonists (corinfar, isoptin) are used.

Ganglioblockers and anticholinergics can influence the neurogenic components of an asthma attack (can be used in combination with bronchodilators: arpenal or fubromegan - 0.05 g three times a day; halidor - 0.1 g three times a day; temehin - 0.001 g three times a day day), which are recommended for mild attacks of a reflex or conditioned reflex nature, with a combination of bronchial asthma with arterial hypertension and pulmonary hypertension. These drugs must be used under the control of blood pressure; they are contraindicated in hypotension. For the treatment of patients with a predominance of the neurogenic component in the pathogenesis, various options for novocaine blockades are used (subject to the tolerance of novocaine), psychotherapy, hypnosuggestive therapy, electrosleep, reflexology, and physiotherapy. These methods are able to eliminate the state of fear, conditioned reflex mechanisms of seizures, anxious mood.

Treatment of concomitant diabetes is carried out according to the general rules: diet, antidiabetic drugs. At the same time, for the correction of carbohydrate metabolism, it is not recommended to use biguanides, which, due to increased anaerobic glycolysis (the mechanism of hypoglycemic action), can aggravate the clinic of the underlying disease.

The presence of esophagitis, gastritis, gastric and duodenal ulcers creates difficulties for glucocorticosteroid therapy. In cases of acute gastrointestinal

bleeding, it is more advisable to use parenteral glucocorticosteroid drugs, an alternative treatment regimen is preferable. The optimal way to treat bronchial asthma complicated by diabetes mellitus and peptic ulcer is the appointment of maintenance inhaled glucocorticosteroid therapy. In hyperthyroidism, there may be a need for increased doses of glucocorticosteroid drugs, since an excess of thyroid hormones significantly increases the rate and changes the metabolic pathways of the latter. Treatment of hyperthyroidism improves the course of bronchial asthma.

In cases of concomitant arterial hypertension, angina pectoris and other cardiovascular diseases, as well as hyperthyroidism, it is necessary to use B-stimulating adrenergic drugs with great care. For persons with impaired function of the digestive glands, it is advisable to prescribe enzyme preparations (festal, digestin, panzinorm), which reduce the absorption of food allergens and can help reduce shortness of breath, especially in the presence of food allergies. Patients with positive tuberculin test results and a history of tuberculosis during long-term glucocorticosteroid therapy are prescribed tuberculostatic drugs (isoniazid) prophylactically.

In elderly patients, the use of adrenergic B-stimulating drugs and methylxanthines is undesirable due to their side effects on the cardiovascular system, especially in coronary atherosclerosis. In addition, the bronchodilating effect of adrenergic drugs decreases with age. With the release of a significant amount of liquid sputum in patients with bronchial asthma of this age group, anticholinergic drugs are useful, which in some cases are more effective than other bronchodilators. There are recommendations on the use of synthetic androgens for elderly men suffering from bronchial asthma with a sharp decrease in the androgenic activity of the gonads (sustanon-250 - 2 ml intramuscularly with an interval of 14-20 days, a course of three to five injections); at the same time, remission is achieved faster and the maintenance dose of glucocorticosteroid drugs is reduced. There are indications of the advisability of using antiplatelet agents, in particular dipyridamole (curantyl) - 250300 mg per day - and acetylsalicylic acid (in the absence of contraindications) - 1.53.0 g per day, especially in elderly patients who have bronchial asthma combined with pathology of the heart - vascular system. In case of microcirculation disorders and changes in the rheological properties of blood, heparin is used at a dose of 10-20 thousand units per day for 510 days.

Treatment of concomitant pathology of the upper respiratory tract is carried out.

Arterial hypertension, bronchial asthma and chronic obstructive pulmonary disease

The drugs of choice for the treatment of arterial hypertension in bronchial asthma and chronic obstructive pulmonary diseases are calcium antagonists and A II receptor blockers.

The risk of prescribing cardioselective beta-blockers in such cases is often exaggerated; in small and medium doses, these drugs are usually well tolerated. With severe bronchospasm and the impossibility of prescribing beta-blockers, they are replaced with calcium antagonists - blockers of slow calcium channels, which in moderate doses have a bronchodilatory effect. However, in severe chronic obstructive pulmonary disease, high doses of slow calcium channel blockers can exacerbate ventilation-perfusion ratio disorders and thereby increase hypoxemia.

Sick chronic obstructive pulmonary disease with intolerance to acetylsalicylic acid, clopidogrel can be prescribed as an antiplatelet agent.

Literature

Arabidze G.G. Belousov Yu.B. Karpov Yu.A. arterial hypertension. Reference guide for physicians. M. 1999.

Karpov Yu.A. Sorokin E.V. Stable coronary heart disease: strategy and tactics of treatment. M. 2003.

Preobrazhensky D.V. Batyraliev T.A. Sharoshina I.A. Chronic heart failure of the streets of the elderly and senile age. Practical cardiology. - M. 2005.

Prevention, diagnosis and treatment of arterial hypertension. Russian recommendations. Developed by the VNOK Expert Committee. M. 2004.

Rehabilitation in diseases of the cardiovascular system / Ed. I.N. Makarova. M. 2010.

Related content:

Obesity and hypertension. Time bomb

Very often, the owners of extra pounds suffer from high blood pressure. In general, being overweight is a ticking time bomb, since it harbors the germ of such serious diseases as diabetes, hypertension, bronchial asthma, and even cancer.

In an organism overflowing with excess products (fat), the tendency and possibility of tumor growth greatly increases, since all conditions are created for the nutrition of abnormal, aggressive cancer cells, a lot of fat and little oxygen - with obesity, tissue redox processes are disturbed! Needless to say, extra pounds of fat make the heart suffer, shortness of breath, pain and deformities in the joints and spine, swelling in the intestines and liver appear. Inflammation of the gallbladder and the deposition in it of all kinds of crystallized metabolic waste, called "stones", is a common companion of obesity.

From all that has been said, one thing is clear: obesity must be treated. But how? There are many "easy" and "pleasant" treatments - from coding, acupuncture, psychic treatment to pills, various "fat burners". Alas, the action of all these methods is based on one mechanism - to influence one way or another on the hormonal system of the body, that is, the system of endocrine glands (thyroid gland, pancreas, adrenal glands, gonads), which closely interact with each other and with brain (coding). These drugs cause its enhanced work - fat burning, with subsequent disturbances in the functioning of the endocrine glands, a variety of malfunctions in it, ranging from thyroid diseases to sexual disorders (menstrual irregularities, impotence) and even diabetes.

Having lost weight during the first months of treatment, people acquire new diseases or overweight soon returns, and most importantly, those diseases that accompany obesity are not cured. But, as folk wisdom says, “you can’t even pull a fish out of a pond without difficulty”, and even more so, you won’t get rid of excess and polluting the body of toxins: fat, pus, stones, mucus, which, clogging our organs, make us sick and die prematurely.

Any disease can be cured only if obey the laws of nature and obey them. It is impossible to fight with nature (and the use of any medicine is a struggle with your own body), it is also impossible to deceive nature (you can eat and lose weight at the same time by using fat burners). Nature can only obey, because she created us according to her own laws.

And the first law of nature, which we are constantly on we destroy, it is purity. The purity of both the external environment, very much disturbed in the form of technology and chemistry, and the internal environment, that is, the organism itself. By the way, this purity is constantly trying to observe the body itself. Despite the fact that we heavily pollute the body with inappropriate and excess food. And then we carefully cleanse the blood and vital organs through the liver, this giant filter, deposit all poisons and toxins in fatty tissue, which is why it is said that fat is a slag sump.

What does hypertension have to do with all this? The most direct: slagged kidneys begin to react with a spasm of their own blood vessels in order to pass less unnecessary toxic metabolic products into them. At the same time, renin begins to be released, causing a persistent spasm of the vessels of the whole organism. Here it goes: diastolic pressure is elevated. And in order to still push blood through these compressed vessels to all organs and not cause blood supply disturbances in them, the heart is forced to work with a double and triple load, work hard, so systolic blood pressure rises - it reaches 200 and above (normal - 120 units). But after all, the pressure rises not only in obese, but also in thin people, although less often. Yes, if the work of the intestines and pancreas is disturbed and thereby the ability to assimilate the food taken is impaired. But the pancreas and intestines do not work well, because they themselves are also contaminated with decay products of body tissues. When they are cleansed of these superfluous, very poisonous products, the work of both the intestines and the kidneys is restored, and the thin (as well as full) acquire normal weight and normal blood pressure.

Yes, true miracles can only be done by nature, that is, natural treatment.

Now a few words about those who treated themselves with nature, and not with drugs: patient Z.T. 62 years old, started treatment at a weight of 125 kg and with a blood pressure of 220/110. For 6 months of treatment, her weight decreased to 80 kg, blood pressure returned to normal completely. Completely changed from wearing to life. Now this is not a sick, old woman who was about to die, but a young, cheerful, full of optimism, who says: “I lost 50 kg of weight and looked 30 years younger and went. to the ballroom dance group.

Patient Barannikova OI, 68 years old, suffered from headaches and high blood pressure for 50 years. One month after the start of treatment, the headaches stopped completely, her blood pressure returned to normal after two months, and after another four months she was completely cured of psoriasis.

Smirnov A. I. had a weight of 138 kg, blood pressure 230/120. Regularly took 2–3 courses of natural treatment per year, in one year the weight decreased to 75 kg and blood pressure became completely normal and stable.

And there are many such examples. Natural healing is not magical healing. If you have been sick for five or twenty years, you will not be cured in one week or one month. You need perseverance and perseverance, as well as faith in the forces of nature.

Read in this article

elderly age;
obesity;
decompensated asthma;
taking medications that have a side effect in the form of hypertension.

Features of the course of hypertension against the background of bronchial asthma is an increased risk of complications in the form of disorders of cerebral and coronary circulation, cardiopulmonary insufficiency. It is especially dangerous that in asthmatics the pressure at night is not sufficiently reduced, 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 systemic hypertension is insufficient oxygen supply due to bronchospasm, which provokes the release of vasoconstrictor compounds into the blood. With a long course of asthma, the arterial wall is damaged. This manifests itself in the form of dysfunction of the inner membrane and increased stiffness of the vessels.

Read more about emergency care for cardiac asthma here.

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

This accelerates the rhythm of contractions and increases cardiac output. The systolic blood pressure rises and the diastolic pressure falls. High pulse blood pressure, sudden tachycardia and the release of stress hormones during an attack lead to a significant circulatory disorder.

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

As you know, blood pressure in almost every person increases with age. However, for asthmatics, the presence of hypertension is a poor prognostic sign. Such patients need special attention and carefully planned drug therapy.

Despite the fact that both diseases are pathogenetically unrelated, it has been found that blood pressure rises quite often in asthma.

Some asthmatics are at high risk of developing hypertension, namely people:

Elderly age.
With increased body weight.
With severe, uncontrolled asthma.
Taking medications that provoke hypertension.

Doctors separately distinguish secondary hypertension. Nominal this form of high blood pressure is more common among patients with bronchial asthma. This is due to the formation of chronic cor pulmonale in patients. This pathological condition develops due to hypertension in the pulmonary circulation, which, in turn, leads to hypoxic vasoconstriction.

These medications include sympathomimetics and corticosteroids. So, Fenoterol and Salbutamol, which are used quite often, in high doses can increase the heart rate and, accordingly, increase hypoxia by increasing myocardial oxygen demand.

It is worth remembering that an asthma attack can cause a transient increase in pressure. This condition is life-threatening for the patient, because against the background of increased intrathoracic pressure and stagnation in the superior and inferior vena cava, swelling of the cervical veins and a clinical picture similar to pulmonary embolism often develop.

Principles of therapy

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

These include:

Beta blockers. A group of drugs that enhances bronchial obstruction, airway reactivity and reduces the therapeutic effect of sympathomimetics. Thus, 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 should be noted that the joint use of diuretics with beta-2-agonists and systemic glucocorticosteroids only enhances unwanted potassium excretion. Also, this group of drugs is able to increase blood clotting, cause metabolic alkalosis, as a result of which the respiratory center is inhibited, and gas exchange indicators deteriorate.
ACE inhibitors. The action of these drugs causes changes in the metabolism of bradykinin, increases the content of anti-inflammatory substances in the lung parenchyma (substance P, neurokinin A). This leads to bronchoconstriction and coughing. Despite the fact that this is not an absolute contraindication to the appointment of ACE inhibitors, preference in treatment is still given to another group of medications.

Another group of medicines, when using which care must be taken, is 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.

What antihypertensive drugs are still allowed to be used in bronchial asthma?

However, in cases where the patient has concomitant severe cardiac arrhythmias (atrioventricular block, severe bradycardia), calcium antagonists are prohibited for use.

Another group of antihypertensive drugs commonly used in asthma are angiotensin II receptor antagonists (Cozaar, Lorista). In their properties, they are similar to ACE inhibitors, however, unlike the latter, they do not affect the metabolism of bradykinin and thus do not cause such an unpleasant symptom as coughing.

Bronchial asthma and hypertension

A number of concomitant diseases require correction of drug therapy of the underlying pathology. Arterial hypertension in bronchial asthma is a fairly common occurrence. Therefore, it is important for the doctor and the patient to know which drugs are contraindicated in the combined course of these diseases. Compliance with simple rules will help to avoid complications and save the patient's life.

The drugs of choice for the treatment of arterial hypertension in bronchial asthma and chronic obstructive pulmonary diseases are calcium antagonists and A II receptor blockers.

Patients with chronic obstructive pulmonary disease with intolerance to acetylsalicylic acid can be prescribed clopidogrel as an antiplatelet agent.

Literature

Arabidze G.G. Belousov Yu.B. Karpov Yu.A. arterial hypertension. Reference guide for physicians. M. 1999.

Karpov Yu.A. Sorokin E.V. Stable coronary heart disease: strategy and tactics of treatment. M. 2003.

Preobrazhensky D.V. Batyraliev T.A. Sharoshina I.A. Chronic heart failure of the streets of the elderly and senile age. Practical cardiology. - M. 2005.

Prevention, diagnosis and treatment of arterial hypertension. Russian recommendations. Developed by the VNOK Expert Committee. M. 2004.

Rehabilitation in diseases of the cardiovascular system / Ed. I.N. Makarova. M. 2010.

Lack of oxygen awakens vascular receptors, which causes an increase in the tone of the autonomic nervous system.
Neurons increase the activity of all processes in the body.
The amount of hormone produced in the adrenal glands (aldosterone) increases.
Aldosterone causes increased stimulation of the artery walls.

This process causes a sharp increase in blood pressure. The data are confirmed by clinical studies conducted during attacks of bronchial asthma.

With a long period of the disease, when asthma is treated with potent drugs, this causes disturbances in the work of the heart. The right ventricle ceases to function normally. This complication is called cor pulmonale syndrome and provokes the development of arterial hypertension.

Bronchial asthma can cause arterial hypertension by itself. The main reason for the development of hypertension are drugs used by asthmatics to relieve attacks.

There are risk factors in which an increase in pressure is more often observed in patients with asthma:

excess weight;
age (after 50 years);
development of asthma without effective treatment;
side effects of drugs.

Some risk factors can be eliminated by making lifestyle changes and following your doctor's recommendations for taking medications.

In order to start treatment of hypertension in time, asthmatics should know the symptoms of high blood pressure:

Strong headache.
Heaviness in the head.
Noise in ears.
Nausea.
General weakness.
Frequent pulse.
Palpitation.
Sweating.
Numbness of hands and feet.
Tremor.
Pain in the chest.

Karpov Yu.A. Sorokin E.V.

RKNPK Ministry of Health of the Russian Federation, Moscow

Bronchial asthma
Chronical bronchitis
emphysema
bronchiectasis

Features of the treatment of hypertension against the background of COPD are due to several factors.

1) Some antihypertensive drugs are able to increase the tone of small and medium bronchi, thereby worsening lung ventilation and aggravating hypoxemia. These agents should be avoided in COPD.

3) Drug treatment of COPD in some cases can significantly change the effectiveness of selected antihypertensive therapy.

With a physical examination, it is difficult to make a diagnosis of cor pulmonale, since most of the signs detected during examination (pulsation of the jugular veins, systolic murmur over the tricuspid valve and increased 2nd heart sound over the pulmonic valve) are insensitive or nonspecific.

It is important to remember that in addition to COPD, the "cor pulmonale" symptom complex can be caused by a number of other causes (sleep apnea syndrome, primary pulmonary hypertension, diseases and injuries of the spine, chest, respiratory muscles and diaphragm, repeated thromboembolism of small branches of the pulmonary artery, severe obesity chest, etc.), the consideration of which is beyond the scope of this article.

The main structural and functional features of "cor pulmonale":

Myocardial hypertrophy of the right ventricle and right atrium
Volume expansion and volume overload of the right heart
Increased systolic pressure in the right heart and pulmonary arteries
High cardiac output (early)
Atrial rhythm disturbances (extrasystole, tachycardia, less often - atrial fibrillation)
Tricuspid valve insufficiency, later pulmonic valve insufficiency
Heart failure in the systemic circulation (in the later stages).

Changes in the structural and functional properties of the myocardium in the syndrome of "cor pulmonale" often leads to "paradoxical" reactions to drugs, including those used to correct high blood pressure. In particular, one of the frequent signs of cor pulmonale are cardiac arrhythmias and conduction disorders (sinoatrial and atrioventricular blockades, tachy- and bradyarrhythmias).

b-blockers

Blockade of b 2 -adrenergic receptors causes spasm of medium and small bronchi. Deterioration of lung ventilation causes hypoxemia, and is clinically manifested by increased dyspnea and increased respiration. Nonselective b-blockers (propranolol, nadolol) block b2-adrenergic receptors, therefore, in COPD, as a rule, they are contraindicated, while cardioselective drugs (bisoprolol, betaxolol, metoprolol) can in some cases (concomitant severe angina pectoris, severe tachyarrhythmia) be prescribed in small doses under close monitoring of ECG and clinical condition (Table 2).

b-blockers with internal sympathomimetic activity (pindolol, acebutolol) have less effect on bronchial tone, but their hypotensive effectiveness is low, and prognostic benefit in arterial hypertension has not been proven. Therefore, when combined with hypertension and COPD, their appointment is justified only according to individual indications and under strict control.

Where is the link between pathologies?

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35% of people with respiratory diseases suffer from hypertension;
during attacks (exacerbations), the pressure rises, and during the period of remission it normalizes.

Some doctors talk about the need to establish a separate diagnosis in asthmatics with high blood pressure - pulmonary hypertension.

Doctors point to direct causal relationships between pathologies:

35% of asthmatics develop arterial hypertension;
during an asthma attack, blood pressure rises sharply;
normalization of pressure is accompanied by an improvement in the asthmatic state (absence of attacks).

Adherents of this theory consider asthma to be the main factor in the development of chronic cor pulmonale, which causes a stable increase in pressure. According to statistics, in children with bronchial attacks, such a diagnosis occurs much more often.

Regardless of whether there is a relationship between bronchial asthma and hypertension, the presence of pathologies should be taken into account in order to choose the right course of treatment. Many blood pressure pills are contraindicated in asthma patients.

After all, different groups of medicines have side effects:

Beta-blockers cause tissue spasm in the bronchi, lung ventilation is disturbed, and shortness of breath increases.
ACE inhibitors (angiotensin-converting enzyme) provoke a dry cough (occurs in 20% of patients taking them), shortness of breath, aggravating the condition of asthmatics.
Diuretics cause a decrease in the level of potassium in the blood serum (hypokalemia), an increase in carbon dioxide in the blood (hypercapnia).
Alpha-blockers increase the sensitivity of the bronchi to histamine. When taken orally, they are practically safe drugs.

reduced symptoms of hypertension;
lack of interaction with bronchodilators;
antioxidant characteristics;
decreased ability to form blood clots;
lack of antitussive effect;
the drug should not affect the level of calcium in the blood.

There are two groups of drugs of this action:

dihydropyridine (Felodipine, Nicardipine, Amlodipine);
non-dihydropyridine (Isoptin, Verapamil).

The drugs of the first group are more often used, they do not increase the heart rate, which is an important advantage.

Diuretics (Lasix, Uregit), cardioselective agents (Concor), a potassium-sparing group of drugs (Triampur, Veroshpiron), diuretics (Thiazid) are also used in complex therapy.

The choice of medications, their form, dosage, frequency of use and duration of use can only be carried out by a doctor. Self-treatment threatens the development of serious complications.

Principles of therapy

There are two scenarios for the development of events:

BP rises during an asthma attack;
pressure does not depend on seizures, constantly elevated.

THE ROLE OF EDUCATIONAL PROGRAMS IN THE MANAGEMENT OF PATIENTS WITH COMBINED PATHOLOGY (BRONCHIAL ASTHMA AND ARTERIAL HYPERTENSION)

The cause of increased systolic and diastolic blood pressure is an increase in the resistance of peripheral vessels and an increase in the pumping function of the myocardium. These are compensatory reactions to oxygen deficiency. In older people, hypertension is a disease that provokes the deposition of atherosclerotic plaques in the vascular walls.

Science news

Asthmatic and hypertensive symptoms

In the presence of a combination of these two pathologies, the following clinical symptoms develop:

Dyspnea. More often it is expiratory in nature. It is more difficult for the patient to exhale than to inhale. The act of breathing in him occurs with the presence of a specific whistle - wheezing.
Cyanosis of the nasolabial triangle and fingertips. This symptom appears as a result of insufficient blood supply to the distal parts of the body.
Cough with a small amount of clear sputum. If there is a layering of a bacterial infection, the discharge becomes yellow or green.
Headache. It often occurs against the background of high blood pressure and is accompanied by mild neurological abnormalities.
Pressure in chest. It is angina pectoris in nature and is provoked by bronchospasm.
Increased symptoms in response to external factors - physical activity, weather changes.
General weakness. It is caused by oxygen starvation of organs and tissues.
Ringing in the ears and flies before the eyes. These phenomena also cause oxygen deficiency.

Cough can be a manifestation of both pathologies at once.

Features of the treatment of hypertension in asthma

A beta-blocker can cause bronchial obstruction or bronchospasm in an asthmatic, block the effect of the use of anti-asthma drugs and inhalations.
ACE drug provokes dry cough, shortness of breath.
A diuretic can cause hypokalemia or hypercapnia.
calcium antagonists. According to studies, the drugs do not cause complications in the respiratory function.
Alpha blocker. When taken, they can provoke an incorrect reaction of the body to histamine.

Therefore, it is so important for patients with asthma and hypertension to be examined by a specialist to select drugs and ensure correct treatment. Any drug in self-medication can complicate not only current diseases, but also worsen general health. The patient on his own can alleviate the course of bronchial disease, so as not to provoke attacks of suffocation, using folk methods: herbal preparations, tinctures and decoctions, ointments and rubbing. But their choice should also be agreed with the doctor.

It is necessary to carefully select pressure pills for asthmatics, since some antihypertensive drugs can aggravate their condition. These dangerous medications include beta-blockers and ACE inhibitors. These drugs are able to increase the constriction of the bronchial tree and increase the formation of mucous secretions in the upper respiratory tract.

The last side effect prevents the therapeutic effect of inhaled sympathomimetics, which stop an asthmatic attack. Hypertension in patients with bronchial asthma is treated with calcium channel blockers. These drugs are optimally suited for hypertensive patients, whose condition is aggravated by asthmatic attacks. Among this group of medicines, preference is given to "Nifedipine" and "Nicardipine". Diuretics are also included in the drug regimen.

RKNPK Ministry of Health of the Russian Federation, Moscow

b-blockers

calcium antagonists

Bronchodilating properties have been proven in phenylalkylamines, short- and long-acting dihydropyridines, and to a lesser extent in benzodiazepine AKs (Table 3).

Angiotensin converting enzyme inhibitors and angiotensin receptor blockers

To date, there are no data on the direct effect of therapeutic doses of ACE inhibitors on lung perfusion and ventilation, despite the proven involvement of the lungs in ACE synthesis. The presence of COPD is not a specific contraindication to the use of ACE inhibitors for antihypertensive purposes. Therefore, when choosing an antihypertensive drug in patients with COPD, ACE inhibitors should be prescribed "on a general basis."

Diuretics

Therefore, the presence of COPD does not limit the use of diuretics for the treatment of concomitant hypertension. With concomitant heart failure with congestion in the pulmonary circulation, diuretics become the means of choice, since they reduce elevated pressure in the pulmonary capillaries, however, in such cases, thiazide diuretics are replaced by loop diuretics (furosemide, bumetanide, ethacrynic acid)

a-blockers and vasodilators

In hypertension, the direct vasodilator hydralazine, or a-blockers prazosin, doxazosin, terazosin, are sometimes prescribed. These drugs reduce peripheral vascular resistance by directly acting on arterioles. These drugs do not have a direct effect on respiratory function, and therefore, if indicated, they can be prescribed to reduce blood pressure.

Rauwolfia preparations

Although in most countries rauwolfia preparations have long been excluded from the official list of drugs for the treatment of hypertension, in Russia these drugs are still widely used, primarily because of their cheapness. Drugs in this group can worsen breathing in some patients with COPD (mainly due to edema of the mucous membrane of the upper respiratory tract).

Drugs of "central" action

There are currently no reports of serious deterioration in breathing in COPD during treatment of hypertension with methyldopa, guanfacine, and moxonidine. However, it should be emphasized that this group of drugs is almost never used for the treatment of hypertension in most countries due to the lack of evidence for improving the prognosis and a large number of side effects.

The effect of drugs used in COPD on the effectiveness of antihypertensive therapy

Thus, the treatment of hypertension against the background of COPD has a number of features. knowledge of which is important both for a pulmonologist and for cardiologists and therapists, since it will significantly improve not only the quality, but also the prognosis of life in patients with combined cardiovascular and pulmonary pathology.

1. Almazov V.A. Arabidze GG// Prevention, diagnosis and treatment of primary arterial hypertension in the Russian Federation - Russian Medical Journal. 2000, vol. 8, No. 8 - pp. 318-342

2. Arabidze G.G. Belousov Yu.B. Karpov Yu.A. “Arterial hypertension. Reference guide for physicians. M. "Remedium", 1999

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6. Chronic obstructive pulmonary disease. federal program

Pathogenetic mechanisms

Regarding whether these two diseases are interconnected, there are two diametrically opposed points of view. One group of honored academicians and professors is of the opinion that one has never and will not affect the other in any way, another group of no less respected people is of the opinion that bronchial asthma is without fail the main causal factor in the development of chronic pulmonary heart, and as a result - secondary arterial hypertension. That is, according to this theory - all asthmatics in the future of hypertension.

An important argument in favor of this particular concept will also be the fact that chronic cor pulmonale, and as a result, secondary arterial hypertension, develops in children and adolescents suffering from bronchial asthma. But are statistics confirmed at the level of physiology? The question is very serious, since by establishing the true etiology, pathogenesis and the relationship of this process with environmental factors, it is possible to develop an optimized treatment regimen.

In order to understand this whole problem, it is necessary to better understand the pathogenesis of the entire process. Chronic cor pulmonale develops only against the background of right ventricular failure, which, in turn, is formed due to increased pressure in the pulmonary circulation. Hypertension of the small circle is caused by hypoxic vasoconstriction - a compensatory mechanism, the essence of which is to reduce the provision of blood flow in the ischemic lobes of the lungs and the direction of blood flow to where gas exchange is intensive (the so-called West areas).

Cause and effect

It should be noted that for the formation of right ventricular failure with its hypertrophy and the subsequent formation of chronic cor pulmonale, the presence of persistent arterial hypertension is necessary. In bronchial asthma, even in the most severe form, there is no constant increase in pressure in the pulmonary vein and artery, and therefore it is somewhat wrong to consider this pathological mechanism as a whole etiological factor in secondary arterial hypertension in bronchial asthma.

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 the relief of bronchospasm by the methods that are used in bronchial asthma (beta2-agonists, glucocorticoids, methylxanthines) and massive hemodilution (infusion therapy).

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 that affect the lung parenchyma, such as scleroderma or sarcoidosis. In this case, yes, their participation in the occurrence of arterial hypertension is fully justified.

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

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

The tactics of 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 against bronchial asthma and avoid contact with the allergen. After all, the treatment of bronchial asthma is carried out according to the Jin protocol, developed by the world's leading pulmonologists. It is in it that a rational stepwise therapy of this disease is proposed.

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, in view of the fact that a lot of effective drugs cannot be used. The same beta-blockers (let's take the latest - nebivolol, metoprolol) - despite all their high selectivity, they still affect the receptors located in the lungs and may well lead to status asthmaticus (silent lung), in which ventolin is no longer exactly will help, in view of the lack of sensitivity to it.

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

From all of the above, the following conclusions can be drawn:

Bronchial asthma itself can cause arterial hypertension, but this happens in a small number of patients, usually with improper treatment, accompanied by a large number of attacks of bronchial obstruction. And then, it will be an indirect effect, through trophic disorders of the myocardium.
A more serious cause of secondary hypertension would be other chronic diseases of the respiratory tract (chronic obstructive pulmonary disease (COPD), many other diseases affecting the lung parenchyma, such as scleroderma or sarcoidosis).
The main cause of the onset of hypertension in asthmatics is the drugs that treat bronchial asthma itself.
The systematic implementation by the patient of the prescribed treatment regimens and other recommendations of the attending physician is a guarantee (but not one hundred percent) that the process will not progress, and if it does, it will be much slower. This will allow you to keep the therapy at the level that was originally prescribed, not to prescribe stronger drugs, the side effects of which will not lead to the formation of arterial hypertension in the future.

Signs of increased blood pressure

An increase in blood pressure in bronchial asthma can be suspected by the following clinical manifestations:

In the most severe cases, against the background of an asthma attack and a crisis, there is a convulsive syndrome, loss of consciousness. 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.