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Special Reports |

Treatment of Systemic Hypertension in Patients With Pulmonary Disease*: COPD and Asthma

Richard A. Dart, MD, FCCP; Steve Gollub, MD, FCCP; Jason Lazar, MD, FCCP; Chandra Nair, MD, FCCP; David Schroeder, MD, FCCP; Steven H. Woolf, MD
Author and Funding Information

*From the Department of Nephrology and Hypertension (Dr. Dart), Marshfield Clinic, Marshfield, WI; Kansas University Medical Center (Dr. Gollub), Kansas City, KS; Winthrop University Hospital (Dr. Lazar), Mineola, NY; Cardiac Center (Dr. Nair), Creighton University School of Medicine and Pharmacy, Omaha, NE; Asheville Cardiology Associates, P.A. (Dr. Schroeder), Asheville, NC; and Virginia Commonwealth University (Dr. Woolf), Fairfax, VA.

Correspondence to: Richard Dart, MD, FCCP, Department of Nephrology, Marshfield Clinic, 1000 North Oak Ave, Marshfield, WI 54449-9916; e-mail: dart.richard@marshfieldclinic.org.



Chest. 2003;123(1):222-243. doi:10.1378/chest.123.1.222
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We present a two-part review of the English-language literature pertaining to drug therapy for systemic high BP in patients with pulmonary diseases. Part I examines the literature pertaining to the use of antihypertensive drugs in patients with systemic hypertension and coexisting pulmonary conditions, especially COPD and asthma. Part II of the series reviews studies assessing the relationship between sleep-disordered breathing (including the role of the sympathetic nervous system) and systemic hypertension, and presents an approach to the management of these patients. It is the aim of both parts of this review to make qualified conclusions and recommendations applying a methodologic critique to assess the current literature. In the first part of this series, we review the demographics of hypertension in patients with COPD. This is followed by an extensive review of the use of specific classes of antihypertensive drug therapies in patients with pulmonary disease. The antihypertensive agents reviewed include diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists, β-adrenergic blocking agents, and α-β-blockers and other non-β-blocker classes. Additionally, the renin angiotensin system is briefly reviewed, with a discussion of how angiotensin-converting enzyme inhibitors induce cough, especially in pulmonary and congestive heart failure patients.


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