What are some examples of medications for hypertension, diabetes, and asthma?

Examples of Medications for Hypertension, Diabetes, and Asthma

The most effective medications for hypertension, diabetes, and asthma include ACE inhibitors, metformin, and inhaled corticosteroids respectively, based on their proven ability to reduce morbidity and mortality.

Hypertension Medications

Hypertension treatment should include drug classes that have demonstrated cardiovascular event reduction in patients with diabetes 1:

First-line options:

• ACE inhibitors (e.g., lisinopril, enalapril, benazepril)

  • Particularly beneficial for patients with diabetes or albuminuria
  • Shown to reduce cardiovascular events and slow kidney disease progression

• Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan, candesartan)

  • Alternative for patients who cannot tolerate ACE inhibitors
  • Recommended first-line for patients with albuminuria

• Thiazide-like diuretics (e.g., chlorthalidone, indapamide)

  • Long-acting agents preferred due to proven cardiovascular benefit
  • Often used in combination therapy

• Dihydropyridine Calcium Channel Blockers (e.g., amlodipine)

  • Effective blood pressure reduction with few metabolic side effects

Second-line/Add-on options:

• Mineralocorticoid Receptor Antagonists (e.g., spironolactone)
  • For resistant hypertension not controlled on three medications
  • Requires monitoring for hyperkalemia

Treatment algorithm:

• For BP 130-150/80-90 mmHg: Start with single agent
• For BP ≥150/90 mmHg: Start with two-drug combination
• For resistant hypertension: Add mineralocorticoid receptor antagonist

Combinations to avoid:

• ACE inhibitor + ARB
• ACE inhibitor/ARB + direct renin inhibitor

Diabetes Medications

First-line:

• Metformin
  • First-line therapy for type 2 diabetes
  • Reduces hepatic glucose production and improves insulin sensitivity
  • Caution with renal impairment and potential for lactic acidosis 2

Second-line options:

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors (e.g., empagliflozin, dapagliflozin)

  • Cardiovascular and renal benefits
  • Weight loss effect

• Glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, dulaglutide)

  • Cardiovascular benefits
  • Weight loss effect

• Dipeptidyl peptidase-4 (DPP-4) inhibitors (e.g., sitagliptin, linagliptin)

  • Weight neutral
  • Well tolerated

• Sulfonylureas (e.g., glipizide, glimepiride)

  • Effective glucose lowering
  • Risk of hypoglycemia

• Thiazolidinediones (TZDs) (e.g., pioglitazone)

  • Improve insulin sensitivity
  • May have additional benefit of reducing asthma risk in overweight/obese patients 3

• Insulin (various formulations)

  • For type 1 diabetes and advanced type 2 diabetes
  • Multiple formulations for basal and prandial coverage

Asthma Medications

Controller medications:

• Inhaled corticosteroids (ICS) (e.g., fluticasone, budesonide)

  • First-line controller therapy
  • Reduce airway inflammation

• Long-acting beta-agonists (LABAs) (e.g., salmeterol, formoterol)

  • Used in combination with ICS
  • Not to be used as monotherapy

• Long-acting muscarinic antagonists (LAMAs) (e.g., tiotropium)

  • Add-on therapy for uncontrolled asthma

• Leukotriene modifiers (e.g., montelukast)

  • Alternative controller option
  • Less effective than ICS

Rescue medications:

• Short-acting beta-agonists (SABAs) (e.g., albuterol, salbutamol)

  • Rescue therapy for acute symptoms
  • Overuse indicates poor control

• Short-acting muscarinic antagonists (SAMAs) (e.g., ipratropium)

  • Additional bronchodilator option
  • Often used in emergency settings

Biologics for severe asthma:

• Anti-IgE (e.g., omalizumab)
• Anti-IL-5 (e.g., mepolizumab, reslizumab)
• Anti-IL-4/IL-13 (e.g., dupilumab)

Important Considerations

Comorbidity management:

• Hypertension is more prevalent in asthmatic patients and associated with increased asthma morbidity 4
• ACE inhibitors may have additional benefits in reducing asthma risk in overweight/obese patients with diabetes or hypertension 3
• Beta-blockers for hypertension should be used cautiously in asthma patients due to potential bronchospasm

Medication interactions:

• Thiazide diuretics may worsen glycemic control in diabetic patients 2
• Corticosteroids (oral) for severe asthma can worsen both hypertension and diabetes
• Some calcium channel blockers may affect glycemic control 2

Special populations:

• In pregnancy, ACE inhibitors and ARBs are contraindicated due to fetal risk 1
• In chronic kidney disease, ACE inhibitors or ARBs are preferred for hypertension management 5
• In elderly patients, start with lower doses and titrate carefully 5

By selecting appropriate medications based on comorbidities and individual patient factors, clinicians can effectively manage these common chronic conditions while minimizing adverse effects and drug interactions.