How does Chronic Obstructive Pulmonary Disease (COPD) impact medication management and target laboratory values/vital signs for patients with Hypertension (HTN) or Diabetes Mellitus (DM)?

From the Guidelines

COPD significantly impacts medication management and target laboratory values/vital signs for patients with Hypertension (HTN) or Diabetes Mellitus (DM), requiring careful consideration of disease interactions and potential side effects. For hypertension in COPD patients:

• Prefer ACE inhibitors or ARBs as first-line treatments, as they do not affect bronchial smooth muscle and have been shown to reduce morbidity and mortality in patients with heart failure and COPD 1
• Avoid non-selective beta-blockers (e.g., propranolol) due to potential bronchoconstriction, but cardioselective beta-blockers (e.g., metoprolol, atenolol) may be used with caution 1
• Target blood pressure: <140/90 mmHg, which is slightly higher than for non-COPD patients, to balance disease management and minimize respiratory side effects For diabetes in COPD patients:
• Metformin remains first-line therapy if not contraindicated, but consider SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) as they may have protective effects on lung function
• Target HbA1c: 7-8%, which is slightly higher than for non-COPD patients, acknowledging the challenges of tight glycemic control in COPD patients, especially during exacerbations requiring steroid treatment
• Monitor blood glucose more closely if using systemic corticosteroids for COPD exacerbations, as they can affect glucose control 1 These guidelines aim to balance disease management while minimizing respiratory side effects, and are based on the most recent and highest quality evidence available, including the European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure 1 and the American Heart Association and American Diabetes Association recommendations for blood pressure control in people with diabetes mellitus 1.

From the Research

Impact of COPD on Medication Management

• COPD is associated with important chronic comorbid diseases, including diabetes, hypertension, and cardiovascular diseases 2
• The presence of COPD could provide a rationale to look for other comorbid diseases, and conversely, the presence of diabetes, hypertension, or cardiovascular disease might be the basis for the assessment of patients for airflow limitation and COPD 2
• Patients with COPD have an increased risk of developing type 2 diabetes mellitus (T2DM) compared with a control group, and hyperglycemia and diabetes have been associated with reduced predicted levels of lung function 3, 4

Target Laboratory Values/Vital Signs for Patients with HTN or DM

• The interaction between the presence and/or treatment of COPD, risk of infection, presence and/or treatment of T2DM, and risk of acute exacerbations of COPD (AECOPDs) can be represented as a vicious circle 3
• Establishing glycemic management is crucial since the reduction in lung function found in people with diabetes might decrease the threshold for clinical manifestations of COPD 3
• Hypertension and hypertriglycemia are important risk factors for type 2 diabetes in patients with COPD 4

Medication Management Strategies

• The use of metformin in patients with coexisting COPD and diabetes mellitus was associated with fewer COPD-specific emergency room visits and hospitalizations, especially in low-complexity COPD 5
• Metformin decreases oxidative stress and inflammation and may benefit patients with COPD 5
• The most effective approach to simultaneously treating T2DM and COPD is to interfere with the shared inflammatory substrate, thus targeting both lung inflammation (COPD) and vascular inflammation (DM) 3