What is the first-line medication for an 80-year-old patient with hypertension and Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

For an 80-year-old patient with hypertension and COPD, a low-dose ACEI or ARB, such as lisinopril or losartan, is the recommended first-line medication choice, considering the patient's age and comorbidities, as suggested by the 2020 international society of hypertension global hypertension practice guidelines 1. When selecting a medication, it's crucial to consider the patient's COPD diagnosis, as some antihypertensive medications can exacerbate respiratory symptoms.

• The guidelines recommend considering monotherapy in low-risk grade hypertension and in patients aged >80 years or frail, with a preference for once-daily dosing and single pill combinations 1.
• ACEIs or ARBs are suitable options for patients with COPD, as they do not adversely affect lung function and can provide additional benefits, such as reducing mortality and morbidity in patients with cardiovascular disease.
• It's essential to start with a low dose, such as 2.5-5 mg daily for lisinopril or 25-50 mg daily for losartan, and gradually titrate the dose to achieve the desired blood pressure target, while monitoring for potential side effects and adjusting the treatment plan as needed.
• Regular monitoring of renal function, electrolytes, and blood pressure response is crucial, with dose adjustments made gradually to avoid orthostatic hypotension and other complications.
• The target systolic blood pressure for elderly patients with COPD is typically between 130-150 mmHg, rather than more aggressive targets used in younger patients, to minimize the risk of adverse effects and ensure optimal quality of life.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

First-Line Medication for Hypertension and COPD

The first-line medication for an 80-year-old patient with hypertension and Chronic Obstructive Pulmonary Disease (COPD) can be determined based on several studies.

• According to 2, the treatment of hypertension in patients 80 years of age or older with indapamide, with or without perindopril, is beneficial and can reduce the risk of stroke, death from stroke, death from any cause, death from cardiovascular causes, and heart failure.
• A study by 3 compared the long-term effects of lisinopril, nifedipine, and conventional therapy in the treatment of mild-to-moderate hypertension in patients with COPD, and found that all three regimens significantly reduced blood pressure, but lisinopril had the best reduction of double product and suppressed the renin-angiotensin system.
• Another study by 4 found that among patients with COPD and hypertension, combination therapy that includes a thiazide diuretic was associated with a significantly lower risk of hospitalization for congestive heart failure (CHF) among patients without a history of CHF.
• Additionally, 5 and 6 suggest that diuretics and angiotensin-converting enzyme (ACE) inhibitors can be considered as first-line therapy for hypertension, especially in patients with comorbid conditions.

Considerations for COPD Patients

When considering the first-line medication for an 80-year-old patient with hypertension and COPD, the following points should be taken into account:

• The patient's age and comorbid conditions, such as COPD, should be considered when selecting the first-line medication 5, 6.
• The use of ACE inhibitors, such as lisinopril, may be beneficial in patients with COPD, as they can suppress the renin-angiotensin system and have favorable effects on metabolic responses 3.
• Combination therapy that includes a thiazide diuretic may be associated with a lower risk of hospitalization for CHF among patients with COPD and hypertension 4.