Newer antihypertensive drug therapies: Are they better for pulmonary patients?

Diuretics are a mainstay of antihypertensive therapy for patients with asthma or chronic obstructive pulmonary disease (COPD); ability to clear airway secretions and, in patients with COPD, electrolyte and acid-base status should be monitored. β-Blockers are contraindicated in asthma and are generally better avoided in COPD; if benefit outweighs risk (as it may in cases of acute myocardial infarction, for example), start with a trial of a low dose of a β ₁-selective agent without intrinsic sympathomimetic activity. α-Blockers and calcium channel blockers have favorable safety profiles with concomitant pulmonary disease; monitor oxygenation and right ventricular function in COPD patients receiving calcium channel blockers. Medications that exert inhibitory effects on the renin-angiotensin-aldosterone system may also have bronchoprotective effects. The new angiotensin II receptor blockers are an option for patients who cannot tolerate angiotensin-converting enzyme inhibitors.