From the Guidelines
For patients with both COPD and CHF, ACE inhibitors (like lisinopril 10-40 mg daily or ramipril 2.5-10 mg daily) or ARBs (such as losartan 25-100 mg daily) are generally recommended as first-line blood pressure medications. Beta-blockers, particularly cardioselective ones like metoprolol succinate (25-200 mg daily) or bisoprolol (2.5-10 mg daily), are also beneficial despite old concerns about their use in COPD, as they reduce mortality in CHF patients 1. These medications not only control blood pressure but also improve outcomes in heart failure.
Key Considerations
- Start with low doses and titrate gradually while monitoring for side effects, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
- Diuretics like furosemide (20-80 mg daily) can help manage fluid overload in CHF but should be used cautiously in COPD patients, considering the potential for exacerbating respiratory symptoms.
- Calcium channel blockers, particularly dihydropyridines like amlodipine (5-10 mg daily), can be added if additional blood pressure control is needed, but their use should be guided by the clinical context and potential for adverse effects.
Monitoring and Adjustment
Regular monitoring of blood pressure, heart rate, lung function, and electrolytes is essential to balance the treatment of both conditions effectively while minimizing adverse effects on either condition. The choice of medication should be individualized based on the patient's specific clinical profile, including the presence of COPD and CHF, and guided by the most recent and highest quality evidence available 1.
From the FDA Drug Label
Amlodipine has been used safely in patients with chronic obstructive pulmonary disease, well-compensated congestive heart failure, coronary artery disease, peripheral vascular disease, diabetes mellitus, and abnormal lipid profiles.
Amlodipine can be used as a blood pressure medication for patients with COPD and CHF, as it has been used safely in these populations 2.
- Key points:
- Safe for use in patients with COPD
- Safe for use in patients with well-compensated CHF
- Can be used in patients with other comorbidities such as coronary artery disease, peripheral vascular disease, diabetes mellitus, and abnormal lipid profiles.
From the Research
Blood Pressure Medication for COPD and CHF
- The management of patients with systemic hypertension and coexisting COPD can present therapeutic challenges, as certain antihypertensive drugs can affect pulmonary function 3.
- Calcium channel blockers and angiotensin II antagonists appear to be the best initial choices for treating hypertension in patients with COPD, although additional studies are needed to determine the best treatment choices 3.
- Combination antihypertensive therapy that includes a thiazide diuretic is associated with a significantly lower risk of hospitalization for CHF among patients with COPD and hypertension, particularly those without a history of CHF 4.
Beta Blockers in Patients with Coexistent HF and COPD
- Beta blockers are under-prescribed in patients with HF and concurrent COPD due to concerns about adverse pulmonary effects 5.
- Bisoprolol use has been shown to have a dose-response survival benefit in patients with coexistent HF and COPD, whereas no survival difference was observed for carvedilol or metoprolol 5.
- The prescription of beta blockers in patients with COPD suffering from HF comorbidity decreases with increasing severity of COPD 6.
Other Medications for COPD and CHF
- Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may have potential benefits in COPD patients, as they can help reduce systemic inflammation and promote the development of extrapulmonary and cardiovascular co-morbidities 7.
- The treatment of COPD with and without HF comorbidity varies according to COPD severity, with a reduction in the prescription of individually administered long-acting β2-agonists (LABAs) and long-acting anticholinergics (LAMAs) observed with increasing severity of the disease 6.