From the Guidelines
For a patient with uncontrolled hypertension on lisinopril and COPD, the best approach is to optimize blood pressure control while considering the patient's COPD, and adding a beta-blocker is not recommended due to potential worsening of bronchospasm, but can be considered with caution if strongly indicated, as suggested by the European Society of Cardiology guidelines 1. The patient's current blood pressure of 160/100 is significantly elevated, and the first step would be to assess adherence to the current lisinopril regimen and consider increasing the dose to 40mg daily if tolerated.
- Key considerations for managing uncontrolled hypertension in a patient with COPD include:
- Avoiding medications that may worsen COPD, such as non-selective beta-blockers
- Using medications that have a beneficial effect on morbidity and mortality, such as ACE inhibitors, as recommended by the European Society of Cardiology guidelines 1
- Considering the addition of a thiazide diuretic or a calcium channel blocker to enhance blood pressure control
- Monitoring for potential drug interactions and side effects, particularly electrolyte abnormalities with diuretics and cough with ACE inhibitors
- For COPD management, the following are recommended:
- Long-acting bronchodilators such as tiotropium (18 mcg inhaled daily) or a long-acting beta-agonist like salmeterol (50 mcg inhaled twice daily)
- Inhaled corticosteroids should be reserved for patients with frequent exacerbations
- Lifestyle modifications including smoking cessation, and regular physical activity should be emphasized as they benefit both conditions The European Society of Cardiology guidelines suggest that agents with documented effects on morbidity and mortality, such as ACEIs, β-blockers, and ARBs, are recommended in patients with co-existing pulmonary disease 1. However, beta-blockers should be used with caution in patients with COPD, and a history of asthma should be considered a contraindication to the use of any β-blocker, as stated in the guidelines 1. Regular follow-up every 2-4 weeks until blood pressure is controlled is essential to adjust therapy as needed, and supervised rehabilitation programmes may be appropriate to improve skeletal muscle function and fatigue in patients with co-existing COPD and hypertension, as suggested by the European Society of Cardiology guidelines 1.
From the Research
Patient Profile
- Age: 68 years
- Sex: Not specified
- Medical History: Hypertension (HTN), Chronic Obstructive Pulmonary Disease (COPD)
- Current Medication: Lisinopril 20mg
- Average Office Blood Pressure: 160/100 mmHg
Management of Uncontrolled Hypertension
- The patient's blood pressure is above the treatment threshold of 160/100 mmHg 2
- The current medication, lisinopril, is an Angiotensin-Converting Enzyme (ACE) inhibitor, which has been shown to reduce all-cause mortality in hypertensive patients 2
- However, the patient's blood pressure is not well-controlled on lisinopril 20mg, indicating the need for adjustment of the treatment regimen
Treatment Options
- Increasing the dose of lisinopril or switching to a different ACE inhibitor may be considered 3
- Adding a thiazide diuretic, such as chlortalidone or hydrochlorothiazide, to the treatment regimen may be effective in reducing blood pressure 2
- Combination therapy with a calcium channel blocker and an ACE inhibitor may also be considered 4
- Twice-daily dosing of lisinopril may be more effective than once-daily dosing in reducing blood pressure 5
Considerations for Patients with COPD
- The treatment regimen should be carefully selected to avoid exacerbating COPD symptoms
- ACE inhibitors, such as lisinopril, are generally considered safe in patients with COPD 6
- However, the patient's lung function and overall health status should be closely monitored when adjusting the treatment regimen