Treatment of hypertension in bronchial asthma. Why does blood pressure rise in asthma?

21.04.2020 -

Bronchial asthma is often accompanied by high blood pressure. This combination refers to an unfavorable prognostic sign of the course of both diseases. Most asthma medications worsen the course of hypertension, and reverse reactions are observed, which must be taken into account when conducting therapy.

Bronchial asthma and hypertension do not have common prerequisites for occurrence - different risk factors, patient population, development mechanisms. The frequent joint course of diseases has become an occasion to study the patterns of this phenomenon. Conditions have been found that often increase blood pressure in asthmatics:

elderly age;
obesity;
decompensated asthma;
taking medications that have side effects in the form of.

Features of the course of hypertension against the background of bronchial asthma is an increased risk of complications in the form of disorders of cerebral and coronary circulation, cardiopulmonary insufficiency. It is especially dangerous that asthmatics do not have enough pressure at night, and during an attack, a sharp deterioration in the form is possible.

One of the mechanisms that explains the occurrence of systemic hypertension is due to bronchospasm, which provokes the release of vasoconstrictor compounds into the blood. With a long course of asthma, the arterial wall is damaged. This manifests itself in the form of dysfunction of the inner membrane and increased stiffness of the vessels.

Signs of increased blood pressure

An increase in blood pressure in bronchial asthma can be suspected by the following clinical manifestations:

In the most severe cases, against the background of an asthma attack and a crisis, there is a convulsive syndrome, loss of consciousness. This condition can develop into cerebral edema with fatal consequences for the patient. The second group of complications is associated with the possibility of developing pulmonary edema due to both cardiac and pulmonary decompensation.

Drugs for hypertension and bronchial asthma

The complexity of the treatment of patients with a combination of hypertension and bronchial asthma lies in the fact that most medications for their therapy have side effects that worsen the course of these pathologies.

Long-term use of beta-agonists in asthma causes a steady increase in blood pressure. So, for example, Berotek and Salbutamol, which are very often used by asthmatics, only in low doses have a selective effect on bronchial beta receptors. With an increase in the dose or frequency of inhalation of these aerosols, receptors located in the heart muscle are also stimulated.

This accelerates the rhythm of contractions and increases cardiac output. The diastolic rises and falls. High pulse blood pressure, a sharp release of stress hormones during an attack lead to a significant circulatory disorder.

Hormonal preparations from the group of corticosteroids, which are prescribed for severe bronchial asthma, as well as Eufillin, which leads to heart rhythm disturbances, have a negative effect on hemodynamics.

Therefore, for the treatment of hypertension in the presence of bronchial asthma, drugs of certain groups are prescribed.

Groups	Drug names
calcium antagonists	Isoptin and Amlodipine
Alpha blockers	Physiotens, Ebrantil
Angiotensin 2 antagonists	Kozaar, Lorista

The use of diuretics is preferable from the group of loop drugs - Lasix, Uregit, as well as potassium-sparing - Veroshpiron and Triampur.

When prescribing antihypertensive drugs, it should be borne in mind that beta-blockers lead to bronchospasm. This impairs pulmonary ventilation and is manifested by shortness of breath, an increase in shortness of breath. This is especially true for drugs with non-selective action.

Low-dose cardioselective agents for concomitant tachycardia and may be used in patients with asthma. The safest for this category of patients is its analogues.

A frequent complication of taking angiotensin-converting enzyme inhibitors is stubborn dryness. Therefore, although these medications do not directly affect the tone of the bronchi, but attacks of shortness of breath, turning into suffocation, respiratory failure significantly worsen the well-being of patients with asthma.

Formation of "Pulmonary heart"

In severe cases, asthmatics develop a symptom complex called cor pulmonale.. Such patients are prone to severe arrhythmias - and they should not use calcium antagonists that slow down the heart rate.

In this regard, all patients who take hormonal drugs and use aerosols to relieve an asthma attack are advised to monitor their pulse rate and blood pressure daily. With a steady increase or decrease in them, you need to contact your doctor to correct therapy.

What antihypertensive drugs can cause dry cough

Dry cough is a side effect of antihypertensive drugs from the group of angiotensin-converting enzyme inhibitors. It especially often occurs when using tablets:

first generation - Enap, Captopril;
constantly and in large doses;
in patients with hypersensitivity to allergens;
in old age;
against the background of chronic bronchitis, bronchial asthma;
in smokers.

A hereditary predisposition to such a reaction has also been established. Cough does not cause complications, but significantly worsens the quality of life of patients, forcing them to take drugs to suppress it. They usually do not help much, and a change of medication is necessary to get rid of it. In this case, it would be best to switch to another group.

Pressure medications that do not cause coughing

It has been proven that pressure medications related to sartans, trade names of medicines, practically do not cause coughing:

Vasar,
Lorista,
Diocorus,
Valsacor,
Kandesar,
Micardis,
Teveten.

pressure pills for asthma

Tablets for asthmatics to lower blood pressure should not narrow the lumen of the bronchi, for this they choose from the following groups:

Drug group	Drug names
calcium antagonists	Isoptin, Corinfar
Sartans	Lorista, Vasar
Alpha-adrenergic blockers	Moxogamma, Estulik
Combined	Arifam, Asomex N

Contraindicated drugs include non-selective beta-blockers (for example, Anaprilin), as they cause bronchospasm. Drugs with a selective effect (Concor) can be used after a heart attack in a small dosage.

Angiotensin-converting enzyme inhibitors are not prescribed, as they provoke coughing and worsen the course of bronchial asthma. Diuretics are acceptable, but their effectiveness in patients with asthmatic conditions is low, it is best to use their combination with calcium antagonists (Arifam).

What cough pills increase blood pressure

Cough preparations that contain in the composition can increase the pressure:

Active substance	Drug names
Salbutamol	Ascoril, Combipack
pseudoephedrine	Caffetin Cold, Gripex
Hormones	Prednisolone, Dexamethasone, Triamcinolone (Polcortolone)

Almost all aerosol medications used by patients to treat bronchial asthma cause an increase in blood pressure.

Does broncholithin increase blood pressure?

Broncholithin can increase blood pressure, as it contains ephedrine. This component constricts blood vessels, which creates a high load on the heart. Therefore, the drug is contraindicated in:

hypertension;
angina;
myocardial infarction;
severe heart disease - myocarditis, arrhythmia, cardiomyopathy;
thyrotoxicosis (increased thyroid function);
widespread atherosclerosis (blockage of the vessels of the heart, brain, limbs).

Broncholithin is contraindicated in myocarditis

Cough as a side effect of blood pressure pills

The development of cough is a side effect when using pressure tablets from the group of angiotensin-converting enzyme inhibitors. This is due to the fact that their therapeutic effect is based on the release of substances (bradykinin) that cause bronchospasm.

Therefore, in patients with prolonged use of Enap, Kapoten, less often Lisinopril and Prestarium, a dry hacking cough occurs. This is an indication for changing the drug, since antitussives do not work on it.

In the presence of bronchial asthma and chronic bronchitis, drugs of this group are undesirable to use. Since patients use medications that dilate the bronchi, they mask the cough reflex. At the same time, the patient's response to anti-asthma drugs decreases, and their dosages need to be increased.

Hypertension and bronchial asthma have different mechanisms of development, but are often combined in one patient. This is due to the negative effect on hemodynamics of oxygen deficiency during bronchospasm, as well as changes in the arterial wall in patients with obstructive pulmonary diseases.

One of the causes of frequent hypertension in asthmatics is the intake of drugs from the group of beta-agonists, steroid hormones. The selection of medications to reduce pressure should be carried out from funds that do not impair ventilation of the lungs.

Useful video

Watch the video about self-help for bronchial asthma:

What is the relationship between diseases?

Doctors have not found a clear answer to this question. They note: people with respiratory diseases do often face the problem of high blood pressure. But further opinions are divided. Some experts insist on the existence of the phenomenon of pulmonary hypertension, which causes an attack of pressure in asthmatic disease. Other experts deny this fact, saying that asthma and hypertension are two diseases that do not depend on each other and are not related. But the link between diseases is confirmed by the following factors:

35% of people with respiratory diseases suffer from hypertension;
during attacks (exacerbations), the pressure rises, and during the period of remission it normalizes.

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Types of hypertension

Arterial hypertension is distinguished as a symptom of exacerbation, as well as hypertension, as a disease that occurs in parallel with asthma. Hypertension is of several types. The disease is divided according to the type of origin, the course of the disease, the level:

Course of the disease

Arterial hypertension in bronchial asthma is treated depending on what causes it. Therefore, it is important to understand the course of the disease and what provokes it. The pressure may rise during an asthma attack. In this case, an inhaler will help to remove both symptoms, which stops the asthma attack and relieves pressure. The situation is different if the patient's hypertension is not tied to asthmatic attacks. In this case, the treatment of hypertension should take place as part of a comprehensive course of therapy. Course of the disease

A suitable medicine for pressure is selected by the doctor, taking into account the possibility of the patient developing the syndrome of "cor pulmonale" - a disease in which the right heart ventricle cannot function normally. Hypertension can be provoked by the use of hormonal drugs for asthma. The doctor must track the nature of the course of the disease and prescribe the correct treatment.

Features of the treatment of hypertension in asthma

Bronchial asthma and high blood pressure should be treated under the supervision of a specialist. Only a doctor can prescribe the right drugs for both diseases. After all, every drug can have side effects:

A beta-blocker can cause bronchial obstruction or bronchospasm in an asthmatic, block the effect of the use of anti-asthma drugs and inhalations.
ACE drug provokes dry cough, shortness of breath.
A diuretic can cause hypokalemia or hypercapnia.
calcium antagonists. According to studies, the drugs do not cause complications in the respiratory function.
Alpha blocker. When taken, they can provoke an incorrect reaction of the body to histamine.

Therefore, it is so important for patients with asthma and hypertension to be examined by a specialist to select drugs and ensure correct treatment. Any drug in self-medication can complicate not only current diseases, but also worsen general health. The patient on his own can alleviate the course of bronchial disease, so as not to provoke attacks of suffocation, using folk methods: herbal preparations, tinctures and decoctions, ointments and rubbing. But their choice should also be agreed with the doctor.

Medicines for hypertension in bronchial asthma

How to lower the pressure?

The pressure may rise unexpectedly and quickly. Getting rid of the disease should be prompt - it is dangerous for humans. There are many options for lowering blood pressure, from medications to herbs, foods, and other treatments.

Norms of indicators

For an adult, the normal blood pressure is 120/80. If the indicators deviate up or down by 10 mm Hg, you should not worry. This is also considered a variant of the norm, and many people live with such numbers all the time.

If they rise to 140/90 or more, then hypertension occurs. The condition of the body worsens, it gives a person discomfort. He may experience the following symptoms:

headache;
noise and pulsation in the ears;
dizziness;
weakness;
fainting;
nausea;
palpable heartbeat;
shortness of breath
insomnia and anxiety.

The best way to find out that the pressure has increased is to buy a blood pressure monitor and learn how to use it. If such a pathology is observed in you often, this is an occasion to urgently consult a doctor. There are many modern drugs that effectively fight hypertension. When this happens rarely, you should know how to reduce the pressure yourself.

How to lower high blood pressure

If high blood pressure occurs, there are general recommendations on what to do in such situations. First you need to make sure that the indicators are really overestimated. Measure and evaluate the result. If the increase is insignificant, you can use the people's advice. To normalize the condition, a decoction of herbs is suitable.

If the cause of the jump is an experienced stressful situation, you need to calm down, lie down and stay in that position in silence.

With a strong increase, only medical treatment will help. For such cases, the drugs "Anaprilin", "Nifedipin", "Verapamil" are suitable. It is good to put a dropper with magnesia (magnesium sulfate), if possible.

The tablet may not work right away. No need to increase the dose or try another drug. The effect will manifest itself within an hour, you need to lie down and wait calmly. Too much medication will only make things worse.

After returning to normal levels, exclude provoking factors - do not smoke at least for the first time, do not drink coffee, strong tea and alcohol. If it was not possible to reduce high pressure, call an ambulance.

Medical preparations

The list of drugs that can quickly bring down high blood pressure includes the following drugs:

They are not suitable for frequent use. If you have any chronic disease that causes hypertensive crises, you need to get a doctor's prescription and undergo a course of treatment. How to reduce the pressure of a one-time nature in this case - the specialist will also tell you. Reducing pressure constantly without affecting the cause is dangerous to health.

"Dibazol". The active substance is Bendazole. Available in the form of tablets with a dosage of 20 mg and a solution for injection of 5 or 10 mg. There is also an option for children - tablets of 4 mg.

The drug blocks cationic channels in the muscles of the walls of blood vessels. The action taken is one of the main ways to relieve pressure.

In parallel with this, the active ingredient affects other parts of the body. It increases the production of interferon and antibodies, with which we fight infections, and also increases the excitation of neural connections in the spinal cord.

Apply 1 tablet 2 hours before or after meals. The course of treatment is prescribed by the doctor, based on individual indications. It is forbidden to use in case of hypersensitivity to the components.

"Pentamine". Belongs to the group of ganglion blockers. Release form - 5% solution for injection. It is indicated for hypertensive crisis, vasospasm, renal colic, bronchial asthma, cerebral and pulmonary edema.

Do not use with hypotension, the presence of glaucoma, after myocardial infarction, thrombophlebitis, renal or hepatic insufficiency, CNS lesions.

It can be used in two ways - intravenously (with a hypertensive crisis and in other emergency situations) and intramuscularly (with vasospasm). The initial dosage makes 1 ml. solution. The maximum single dose is 3 ml. After the administration of the drug, the patient should lie down for at least 2 hours, as it is possible to relieve the pressure too abruptly and worsen the condition.

Furosemide. This is a diuretic drug. Due to the removal of excess fluid from the body, the load on the walls of blood vessels is reduced, which allows lowering blood pressure.

Release form - tablets of 40 mg of the active substance. Indications: edema in diseases of internal organs (liver, kidneys, heart) and arterial hypertension.

Pressure-reducing tablets for hypertension have contraindications:

kidney or liver failure,
urinary system disorders
low pressure,
pregnancy and lactation,
age up to 3 years,
violation of water-salt metabolism,
hypersensitivity to the components of the drug.

High blood pressure suggests a dosage of mg. This remedy is usually used in combination with other drugs for hypertension. When used together, the dose of another drug is halved.

Anaprilin. The active substance is Propranolol. Produced in the form of tablets of 10 and 40 mg. It belongs to the group of beta-blockers - these are blood pressure lowering and antiarrhythmic drugs. It has concomitant effects on the body - contraction of the uterus, increased tone of the bronchi, a decrease in intraocular pressure.

Apply 40 mg 2 times a day. The maximum dose per day is 320 mg.

"Nifedipine". Dosage form - tablets of 10 mg. Purpose - angina pectoris and hypertension. It belongs to the group of calcium channel blockers. Apply 1 tablet 2 or 3 times a day during or after meals. The daily maximum is 40 mg.

"Verapamil". It is also a calcium channel blocker. They produce tablets of 40 and 80 mg. Indications: angina pectoris, disturbances in the normal rhythm of the heart, arterial hypertension.

Single dose - mg. May be used 3-4 times a day. But usually the number of doses and dosage are calculated individually by the attending physician.

Non-pharmacological ways to solve the problem

How to relieve high blood pressure without resorting to medication? You can use folk recipes, namely, decoctions of herbs. For these purposes, medicinal plants are used, which also have a sedative effect:

All these herbs can be found in any pharmacy. The dosage and the correct method of preparation are indicated on the package. Do not overdose - in large quantities, decoctions from medicinal plants can be harmful to health. The manufacturer's recommendations on how to deal with high blood pressure must be strictly adhered to.

You can brew grass not only for oral administration. Add the decoction to a bath of warm water and soak in it for half an hour. This procedure will calm and help reduce pressure indicators.

What foods can help lower blood pressure

An unusual way to lower blood pressure is to use food. Natural healers include nuts, milk, bananas, garlic. To improve the condition of the body, it is useful to use berries.

Kefir will help to cope with the disease. Pour it into a glass, add a spoonful of cinnamon, mix and drink quickly.

Another product that can reduce blood pressure is beets. In folk medicine, a recipe for a mixture of beetroot juice and honey is known. It will help reset the tonometer a little. You need to mix the products in equal quantities. There are recommendations for the course of taking this natural medicine. Take ½ teaspoon 3 times a day. The duration of treatment is 1 month.

Do not drink freshly squeezed beetroot juice. Let it brew for a day. Otherwise, its action will be the opposite - it will damage the blood vessels.

Fans of folk recipes know how to reduce pressure - with the help of watermelon seeds. They are dried and ground in a blender to a powder state. In this form, take it ½ teaspoon 3 times a day for 3-4 weeks.

There is a recipe for the elderly, which will help not only relieve pressure, but also strengthen the body as a whole. Cut the lemon and orange into pieces and crush to a state of porridge along with the zest. One intake of citrus mixture per day will be enough for a positive result. Before meals, eat one teaspoon of this remedy.

How to quickly bring down the pressure?

If sometimes you feel unwell, and the tonometer readings greatly exceed the norm, you need to remember a few rules on how to lower the pressure without the use of drugs. Here are the main recommendations:

Exposure to a hot stream of water on the back of the head for several minutes.
contrast baths. For half an hour, immerse your feet alternately in hot and cold water with an interval of 2-3 minutes.
Hot baths. We keep our hands in hot water for a minute.
We mix 3 components: half a lemon (can be crushed in a blender), a spoonful of honey and a glass of mineral water. We drink the resulting remedy in one gulp and wait for relief - hypertension decreases after 30 minutes.
Massage. This method will calm and help lower pressure, as a relaxing and sedative remedy. Especially if someone close makes it. But if you want, you can do it yourself. We start with the head, neck, chest. We go down to the abdomen and shoulder blades. After the procedure, you should lie down so as not to feel bad when lowering.
Soak a cloth in apple cider vinegar and apply to your feet. The effect will begin in 15 minutes.
Fresh air. If it is not possible to leave the room and take a walk, be sure to open the windows.
Hold your breath for 2-3 minutes. This is done on the exhale for 8-10 seconds.

If there is an option to reduce blood pressure without medication, use it. When such a jump in pressure is not associated with an internal disease, but is provoked by external factors (stress, weather), alternative methods really help. And they are much more useful and safer than drugs.

There are many answers to the question “how to bring down high blood pressure”. The most common is drugs. But there are many other effective ways. If there is no effect from self-treatment, call a doctor - a long time for the development of pathology can be dangerous. Try to protect yourself from stressful situations. Stay outdoors more, do light exercise, eat right, get rid of excess weight and bad habits - hypertension will bypass you.

Pressure drugs that do not cause cough: what to do when taking

Drug treatment of hypertension is necessary, as this will normalize the state of blood pressure and prevent the development of a number of complications, such as heart attack and stroke.

However, drugs for arterial hypertension can be taken only after a doctor's prescription. After all, there are different groups of drugs that have different effects and have a number of side effects, such as dizziness, increased urination, cough, and so on.

You can’t do without drug therapy, because high blood pressure has a slow destructive effect on the entire body. But most often, the kidneys, heart and brain suffer from hypertension.

What should be done to prevent the development of complications? Antihypertensive medications should be taken regularly, because this is the only way to control blood pressure.

All drugs for high blood pressure are divided into groups. They can be used as monotherapy or combined with each other to enhance the effect and reduce side effects.

Types of drugs for pressure

Diuretics. Diuretic drugs can quickly reduce pressure indicators by removing salts and excess fluid from the body. For rapid normalization of blood pressure, the use of potassium-sparing diuretics and saluretics (Dicarb, Hypothiazid, Furosemide, and others) is recommended.

These diuretic drugs remove not only water from the body, but also calcium and sodium salts. However, a deficiency of potassium salts negatively affects the functioning of muscles, including the myocardium.

But what if you need to lower your blood pressure? For these reasons, along with saluretics, preparations containing potassium salts - Asparkam or Panangin should be taken.

Potassium-sparing diuretics for hypertension, such as Triamterene, do not remove potassium. But in case of their illiterate use, they can accumulate in the blood, which also adversely affects the body.

It is worth noting that diuretics do not cause cough, but they can provoke a disorder of the water-salt balance, as a result of which such side effects develop as:

nausea
dizziness;
malaise;
problems with heart;
pressure drop, etc.

Popular diuretics are Hydrochlorothiazide, Spironolactone, Indapamide, Triampur, Diuver and others.

Beta blockers. They are used to lower high blood pressure that occurs against the background of heart problems, such as coronary artery disease. The drugs act on the cardiovascular system of adrenaline, they block the beta receptors of adrenaline, which is sensitive to this substance.

At the same time, the vessels, including the coronary ones, expand, as a result of which the heart rhythm normalizes and pressure indicators decrease. As a rule, beta-blockers such as Bisoprolol, Metoprolol, Celiprolol are prescribed to young patients with heart problems.

Due to peripheral vasoconstriction, β-blockers should not be taken by patients with impaired blood circulation in the extremities.

Calcium channel blockers. In addition to lowering blood pressure, such drugs are used for heart disease. CCBs block the entry of calcium into muscle cells, inhibiting their contraction.

With a lack of calcium, the smooth muscles of the walls of blood vessels do not contract as necessary. As a result, the vessels relax, the blood flow inside them is facilitated and the pressure decreases.

Prominent representatives of CCB are the following drugs:

ACE inhibitors. These pills dilate blood vessels. ACE is an enzyme involved in the synthesis of a substance that has a strong vasoconstrictor effect - angiotensin II.

Basically, ACE inhibitors are indicated for hypertension, which develops against the background of heart and kidney diseases. Also, drugs belonging to this group are indicated for high diastolic pressure and in case of increased stress on the heart muscle.

However, with regular use of ACE inhibitors, a dry cough appears. What to do in this case? Often, the doctor prescribes antihypertensive drugs belonging to a different group.

Popular remedies from this group are Ramipril, Perindopril, Enalapril.

Angiotensin II receptor blockers. These drugs control blood pressure for 24 hours. However, in order to achieve a steady decrease in blood pressure, they need to be drunk for at least 3 months.

It is noteworthy that angiotensin 2 receptor blockers have practically no side effects, including they do not cause cough.

Means of central action. Popular representatives of this drug group are Moxonidine, Methyldopa and Albarel. Such drugs bind to receptors in nerve cells, regulating the activity of the SNS and reducing the intensity of vasoconstrictive signals. As a result, vasospasm is removed, and the pressure figures are falling.

It is worth noting that the tablets that have a central effect of the previous generation (Clonidine) are now practically not used in the treatment of hypertension.

What blood pressure medications cause coughing?

Most often, a dry cough develops after taking ACE inhibitors. As a rule, it is this side effect that causes the treatment to be canceled.

It is worth noting that a cough may appear as a result of therapy with any drugs from this group. But most often, such a negative symptom develops during treatment with Enalapril and Captopril. Moreover, cough occurs twice as often after taking Enalapril.

It is worth noting that after taking ACE inhibitors in patients with CHF, such a side effect appears much more often than in hypertensive patients (26% and 15%). Causes of its occurrence include an increase in the concentration of bradykinin, which accumulates in the upper respiratory tract, causing coughing.

In addition, a hereditary predisposition to the appearance of cough after taking ACE inhibitors is assumed. In this case, the patient feels an unpleasant tickling in the back of the throat.

Basically, the cough is paroxysmal, dry, long and hacking. It often worsens when the patient is in the supine position, which can lead to hoarseness and even incontinence and vomiting.

Moreover, these phenomena are not accompanied by hypersensitivity, symptoms of bronchial obstruction or changes in the functioning of the kidneys. What to do to eliminate cough after taking ACE inhibitors? According to some studies, in order to eliminate a cough, it is enough to reduce the dosage of the drug.

The time from the start of therapy with ACE inhibitors and until the onset of an unpleasant symptom can be from 1 day to 1 year. But on average, it appears 14.5 weeks after regular use of the remedy.

It is worth noting that the cough reflex that develops while taking an ACE inhibitor is basically not dangerous for the patient's health, often it just causes discomfort. But it was found that in patients with such a symptom, the quality of life worsens and they are more prone to depressive states.

To establish whether the cough is caused by the use of ACE inhibitors, they must be discontinued for 4 days. As a rule, the symptom disappears after 1-14 days. But if the treatment is resumed, then it can develop again.

What to do and what medications can be used to suppress the cough reflex after taking an ACE inhibitor? To eliminate cough, the following drugs are used:

In addition to ACE inhibitors, cough can develop against the background of lowering blood pressure with beta-blockers. Such drugs affect sensitive receptors located in the vessels, heart and bronchi.

When the blood vessels constrict, a dry, unproductive cough appears. It can also occur with physical activity and a change in body position.

What medications are safest to use for hypertension?

Today, calcium channel blockers are increasingly used in the treatment of hypertension. They have a specific effect on organs and a minimum number of adverse reactions.

New tablets from this group can bind to calcium channels in cell membranes located in the vascular walls and myocardium.

When calcium enters the cell, the following happens:

increased excitability and conductivity;
activation of metabolic processes;
muscle contraction;
increase in oxygen consumption.

However, some modern tablets from this group infringe on such processes. These include the following drugs:

Calcium channel blockers have a number of advantages. So, in addition to lowering pressure, they improve the general well-being of hypertensive patients and are well tolerated in old age. And modern CCBs reduce hypertrophy in the left ventricle and do not suppress physical and mental activity.

In addition, calcium channel blockers do not cause depression and do not increase bronchial tone, which cannot be said about adrenoblockers. Therefore, such drugs are recommended if hypertension is combined with broncho-obstructive diseases.

CCBs also improve the excretory function of the kidneys and have a positive effect on the carbohydrate metabolism of uric acid and lipids. Due to this property, they are superior to thiazide diuretics and adrenoblockers.

In addition to CCB, diuretics are increasingly being used for hypertension, which remove salts and fluid from the body, reducing blood volume, thereby reducing blood pressure. Modern safe diuretics are:

Also, in hypertension, to enhance the effect and reduce adverse reactions, including cough, it is customary to combine antihypertensive drugs.

It is worth noting that with a competent combination, some drugs neutralize the side effects of each other. Therefore, each patient suffering from high blood pressure should know the compatibility of drugs used in the treatment of arterial hypertension.

During treatment with combined drugs, the incidence of hypertensive complications is significantly reduced. Often 2 or 3 are combined. The most effective combinations of 2 drugs are:

ACE inhibitor + diuretic;
Calcium antagonist + receptor blocker;
Receptor blocker + diuretic;
Calcium antagonist + ACE inhibitor;
Calcium antagonist + diuretic.

Such combinations are the optimal solution in the treatment of hypertension. Effective combinations of three drugs are:

ACE inhibitor + AKD + BB;
AKD + BB + diuretic;
BRA + AKD + BB;
BB + ARB + diuretic;
ACE inhibitor + AK + diuretic;
BB + diuretic + ACE inhibitor;
ARB + AK + diuretic.

In addition, there are combination drugs that combine two active ingredients in one tablet at once. These include Enzix duo forte (enalapril and indapamide), Lodoz, Aritel plus (hydrochlorothiazide and bisoprolol), Co-diovan (hydrochlorothiazide and valsartan), and Logimax (metoprolol and felodipine).

Also popular combined agents are Gizaar, Lorista N/ND, Lozap plus (hydrochlorothiazide and losartan), Exforge (amlodipine and valsartan), Atacand plus (hydrochlorothiazide and candesartan), and Tarka (verapamil and trandolapril).

However, absolutely safe means that do not cause any adverse reactions do not exist. But there are modern antihypertensive drugs that have a number of advantages over other drugs. This allows them to have a minimum number of adverse reactions, because new components make such tablets not so dangerous.

Some of the best modern antihypertensive drugs are selective imidazoline receptor agonists. Such drugs rarely provoke the appearance of adverse reactions, quickly normalize blood pressure and they have practically no contraindications. Popular drugs from this group are Monoxidine or Rilmenidine.

In addition, it is worth choosing drugs that have a quick effect and a prolonged effect, which allows you to minimize the risk of adverse reactions. Therefore, it is preferable to choose complex agents that practically do not have adverse reactions, which makes them the best choice in the fight against hypertension.

One of the safest third-generation drugs is Physiotens. After taking it, there is practically no increased drowsiness, coughing and drying of the oral mucosa.

This is a new remedy for high blood pressure without adverse reactions, which does not adversely affect the respiratory function, so Physiotens can be taken even with bronchial asthma. In addition, the drug increases insulin sensitivity, which is important for insulin-dependent patients suffering from diabetes. In detail about the types of tablets, the patients themselves will tell in the video in this article.

What is the electrical axis of the heart?

The electrical axis of the heart is a concept that reflects the total vector of the electrodynamic force of the heart, or its electrical activity, and practically coincides with the anatomical axis. Normally, this organ has a cone-shaped shape, directed with its narrow end down, forward and to the left, and the electrical axis has a semi-vertical position, that is, it is also directed down and to the left, and when projected onto a coordinate system, it can be in the range from +0 to +90 0.

Causes of deviations from the norm
Symptoms
Diagnostics
Treatment

An ECG conclusion is considered normal, which indicates any of the following positions of the axis of the heart: not rejected, has a semi-vertical, semi-horizontal, vertical or horizontal position. Closer to the vertical position, the axis is in thin, tall people of asthenic physique, and to the horizontal position, in strong stocky faces of hypersthenic physique.

The range of position of the electrical axis is normal

For example, in the conclusion of the ECG, the patient may see the following phrase: "sinus rhythm, EOS is not rejected ...", or "the axis of the heart is in a vertical position", which means that the heart is working correctly.

In the case of heart diseases, the electrical axis of the heart, along with the heart rhythm, is one of the first ECG criteria that the doctor pays attention to, and when deciphering the ECG by the attending physician, it is necessary to determine the direction of the electrical axis.

How to determine the position of the electrical axis

Determining the position of the axis of the heart is carried out by a doctor of functional diagnostics, deciphering the ECG, using special tables and diagrams, according to the angle α ("alpha").

The second way to determine the position of the electrical axis is to compare the QRS complexes responsible for the excitation and contraction of the ventricles. So, if the R wave has a greater amplitude in the I chest lead than in the III one, then there is a levogram, or a deviation of the axis to the left. If there is more in III than in I, then a rightogram. Normally, the R wave is higher in lead II.

Causes of deviations from the norm

Axis deviation to the right or to the left is not considered an independent disease, but it can indicate diseases that lead to disruption of the heart.

Deviation of the axis of the heart to the left often develops with left ventricular hypertrophy

Deviation of the axis of the heart to the left can occur normally in healthy individuals who are professionally involved in sports, but more often develops with left ventricular hypertrophy. This is an increase in the mass of the heart muscle with a violation of its contraction and relaxation, necessary for the normal functioning of the whole heart. Hypertrophy can be caused by such diseases:

cardiomyopathy (increase in mass of the myocardium or expansion of the heart chambers) caused by anemia, hormonal disorders in the body, coronary heart disease, postinfarction cardiosclerosis, changes in the structure of the myocardium after myocarditis (inflammatory process in the heart tissue);
long-term arterial hypertension, especially with constantly high pressure figures;
acquired heart defects, in particular stenosis (narrowing) or insufficiency (incomplete closure) of the aortic valve, leading to impaired intracardiac blood flow, and, consequently, increased stress on the left ventricle;
congenital heart defects are often the cause of the deviation of the electrical axis to the left in a child;
violation of conduction along the left leg of the bundle of His - complete or incomplete blockade, leading to impaired contractility of the left ventricle, while the axis is rejected, and the rhythm remains sinus;
atrial fibrillation, then the ECG is characterized not only by axis deviation, but also by the presence of non-sinus rhythm.

In adults, such a deviation, as a rule, is a sign of right ventricular hypertrophy, which develops with such diseases:

diseases of the bronchopulmonary system - prolonged bronchial asthma, severe obstructive bronchitis, pulmonary emphysema, leading to an increase in blood pressure in the pulmonary capillaries and increasing the load on the right ventricle;
heart defects with damage to the tricuspid (tricuspid) valve and the valve of the pulmonary artery extending from the right ventricle.

The greater the degree of ventricular hypertrophy, the more deviated the electrical axis, respectively, sharply to the left and sharply to the right.

Symptoms

The electrical axis of the heart itself does not cause any symptoms in the patient. Disorders of well-being appear in a patient if myocardial hypertrophy leads to severe hemodynamic disturbances and to heart failure.

The disease is characterized by pain in the region of the heart

Of the signs of diseases accompanied by a deviation of the axis of the heart to the left or right, headaches, pains in the region of the heart, swelling of the lower extremities and on the face, shortness of breath, asthma attacks, etc. are characteristic.

If any unpleasant cardiac symptoms appear, you should consult a doctor for an ECG, and if an abnormal position of the electrical axis is found on the cardiogram, an additional examination should be performed to establish the cause of this condition, especially if it is found in a child.

Diagnostics

To determine the cause, if the ECG axis of the heart deviates to the left or right, a cardiologist or therapist may prescribe additional research methods:

Ultrasound of the heart is the most informative method that allows you to evaluate anatomical changes and identify ventricular hypertrophy, as well as determine the degree of violation of their contractile function. This method is especially important for examining a newborn child for congenital heart disease.
ECG with exercise (walking on a treadmill - treadmill test, bicycle ergometry) can detect myocardial ischemia, which can be the cause of deviations of the electrical axis.
24-hour ECG monitoring in the event that not only axis deviation is detected, but also the presence of a rhythm not from the sinus node, that is, there are rhythm disturbances.
Chest X-ray - with severe myocardial hypertrophy, an expansion of the cardiac shadow is characteristic.
Coronary angiography (CAG) is performed to clarify the nature of coronary artery lesions in coronary artery disease a.

Treatment

Directly, the deviation of the electrical axis does not need treatment, since this is not a disease, but a criterion by which it can be assumed that the patient has one or another cardiac pathology. If any disease is detected after the additional examination, it is necessary to begin its treatment as soon as possible.

In conclusion, it should be noted that if the patient sees in the conclusion of the ECG a phrase that the electrical axis of the heart is not in a normal position, this should alert him and prompt him to consult a doctor to find out the cause of such an ECG - a sign, even if there are no symptoms does not occur.

Vol. 15, No. 1 / 2009 ORIGINAL ARTICLE

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Antihypertensive therapy in patients with a combination of hypertension and bronchial asthma

E.A. Latysheva*, G.E. Gendlin**, G.I. Storozhakov**, O.M. Kurbacheva*

*SSC Institute of Immunology, Federal Medical and Biological Agency of Russia, Moscow

**Russian State Medical University of the Ministry of Health of the Russian Federation, Moscow

The prevalence of combined pathology of the cardiovascular and respiratory systems is extremely high. This article discusses the features of the course of hypertension in the presence of bronchial asthma, in which the pulmonogenic component contributes to the increase in blood pressure. The results of our own analysis of data from outpatient records of patients with bronchial asthma and arterial hypertension (n = 1655), which revealed extremely low blood pressure control in this group of patients, are presented. The article also discusses issues related to the treatment of arterial hypertension in people with bronchopulmonary diseases.

Key words: hypertension, bronchopulmonary diseases, bronchial asthma, calcium antagonists, isoptin CP.

Antihypertensive therapy in patients with coexisting hypertension and bronchial asthma

E.A. Latysheva*, G.E. Gendlin**, G.I. Storozhakov**, O.M. Kurbacheva*

* Russian immunology institution, Moscow ** Russian state medical university, Moscow

The prevalence of concomitant cardiovascular and pulmonary diseases is high. Hypertension characteristics in patients with bronchial asthma, having impact on blood pressure increase via pulmonogenic mechanism, are discussed. The analysis of out-patient data of subjects with concomitant hypertension and bronchial asthma (n = 1655) showed an inadequate blood pressure control in these patients. Also some questions of hypertension management in patients with pulmonary diseases are discussed.

Key words: hypertension, bronchopulmonary pathology, bronchial asthma, calcium antagonists, Isoptin SP.

The article was received by the editors: 20.02.09. and accepted for publication: 26.02.09.

The success and safety of antihypertensive therapy to a large extent depends on the presence and nature of comorbidities in the patient. In the clinic of internal diseases, a combination of hypertension (AH) with bronchopulmonary diseases (BLD) is often detected, which should be the subject of interaction between cardiologists, pulmonologists and allergists.

According to various researchers, the combination of HD and BLZ with obstructive syndrome (bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD)) varies in a fairly wide range of 6.8-76.3%, averaging 34.3%. In recent years, there has been a significant increase in the proportion of patients with a combination of these diseases.

At the same time, in accordance with the conclusions of the National Lung Health Education Program Executive Committee, the percentage of patients suffering from arterial hypertension (AH) and having concomitant BLD corresponds to the general population, while more than a third of patients with BA (and COPD) have concomitant hypertension. In moments of exacerbation of BLZ, the number of people in need of antihypertensive therapy increases even more. Thus, BLZ

with obstructive syndrome should be considered as an independent risk factor for the onset and deterioration of the course of hypertension and, possibly, its prognosis.

Asthma occupies one of the leading places in the structure of lung diseases with obstructive syndrome. According to a meta-analysis by Eagan et al. (2005), about 6% of the adult population of the world suffers from asthma, while both domestic and foreign researchers note a continuing increase in the incidence.

The prevalence of BA in different regions of our country, according to the materials of the 10th National Congress on Respiratory Diseases, varies from 2.6 to 20.3%. Until now, the annual mortality from BA in the world remains at a fairly high level, % of calls to the ambulance service are associated with non-stopping BA attacks.

We analyzed 6866 outpatient records of patients with BA who applied to the NGO State Scientific Center of the Institute of Immunology of the Federal Medical and Biological Agency of Russia in 2002-2004. Of them

24.1% (1655 people) had concomitant hypertension, and only 32.38% of them (536 people) received any (including inadequate) antihypertensive therapy.

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Figure 1. Distribution of people with hypertension and bronchial asthma

□ only BD iBA + GB

Notes: BA - bronchial asthma;

GB - hypertension.

Figure 2. Number of patients receiving antihypertensive therapy

■ no treatment □ adequate □ inadequate

Thus, it turned out that 67.6% of patients did not receive antihypertensive therapy (underlined by the authors).

After analyzing the antihypertensive therapy received by patients, it was found that the target blood pressure (BP) figures were achieved only in a third of patients (Fig. 2).

A more detailed understanding of the characteristics of patients with a combination of BA and HT, and the features of the ongoing antihypertensive therapy, was obtained by studying 500 outpatient cards.

The predominance of women is noteworthy (they accounted for 64%), perhaps this is due to more frequent seeking medical help. According to the severity of BA, men and women were comparable, although women had slightly more severe forms of BA (4.4% compared to 3.4% in men).

In 2/3 of patients who received any therapy for the correction of blood pressure, it remained elevated. This was due to a number of reasons.

1. 68.4% of all patients with uncorrected blood pressure on the background of antihypertensive therapy were treated with modern drugs. The ineffectiveness of treatment in this case was associated with the use of inadequate doses of drugs used as basic therapy. Thus, short-acting drugs were taken once a day or antihypertensive drugs were taken at doses below the average therapeutic and target ones.

2. 11.3% of patients received “old-fashioned drugs” as basic therapy, with an unproven efficacy and safety profile (adelfan, clonidine, and others).

3. 20.3% of patients took drugs that did not have a direct hypotensive effect (andipal, no-shpa, baralgin and others) to correct high blood pressure (Fig. 3.)

Figure 3. Reasons for the ineffectiveness of antihypertensive therapy in patients with bronchial asthma and arterial hypertension

□ modern drugs in inadequate dosages ■ "old-fashioned" drugs

□ drugs that do not have an antihypertensive effect

In accordance with these data, control over concomitant hypertension in patients with asthma was extremely low. Often this is due to the fears of the patient and the doctor associated with the effect of antihypertensive drugs on the course of asthma. In addition, there is a clear trend towards the treatment of the so-called priority disease that the patient has, in this case AD, which is largely due to the presence of medical and economic standards.

The presence of BA and COPD determines the features of the course of GB, since in these diseases the so-called pulmonogenic effect contributes to the increase in blood pressure.

Table 1

CHARACTERISTICS OF PATIENTS WITH COMBINATION OF HYPERTENSION AND BRONCHIAL ASTHMA

(based on the analysis of 500 outpatient patient records)

Gender Characteristic - Men (n = 180) Women (n = 320)

Age, years 58 (30-76) 64 (38-79)

Moderate BA, % 58.5 63.7

Mild BA, % 38.1 31.5

Severe BA, % 3.4 4.8

Atopy, % 70.6 78.4

SBP at the time of visiting the doctor, mm Hg Art. 158.4 (110-210) 165.2 (120-200)

DBP at the time of visiting the doctor, mm Hg Art. 94.3 (70-120) 92.1 (70-120)

Notes: BA - bronchial asthma; SBP - systolic blood pressure; DBP - diastolic blood pressure.

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|YU8II1YA1IK____

^hypertension

component - rise in blood pressure at the time of an asthma attack or an increase in bronchial obstruction. This leads to a change in the blood pressure profile, which can often appear as non-dipper and night-picker curves. Therefore, in the daytime, the indicators of "office" blood pressure may correspond to the target values, and antihypertensive therapy is not prescribed for a long time.

Taking into account the peculiarities of changes in the body associated with BA, the course of AH is also aggravated by the influence of the following factors: arterial hypoxemia, hypercapnia, hemodynamic disturbances in the pulmonary circulation, microcirculatory (increased platelet and erythrocyte aggregation) and hemorheological disorders (erythrocytosis) observed during exacerbations or permanent against the background of severe asthma and COPD.

Currently, there are no objective data on the percentage of AH patients with concomitant BA, however, according to the results of single publications, about 30% of BA patients suffer from HA.

As mentioned above, lung diseases themselves are an independent risk factor for the development of cardiovascular diseases, including systemic hypertension. Such comorbidity, for all its practical significance, has an ambiguous interpretation regarding the pathogenetic relationship between AH and BLZ with obstructive syndrome.

Currently, there are 2 points of view on the combination of these diseases. The first one considers the coexistence of two diseases developing under the influence of various risk factors, pathogenetically unrelated, that is, we are talking about a combination of two independent diseases. The second is the pathogenetic relationship between them. In this case, AH develops against the background of already existing BLZ, that is, AH is a consequence of the underlying disease. This makes it possible to consider hypertension in this category of patients as symptomatic. However, the attempt to isolate pulmonogenic hypertension still causes a lot of controversy.

Alveolar hypoxia in patients with BLD causes vasoconstriction through direct and indirect mechanisms. The direct effect of hypoxia is associated with the development of depolarization of vascular smooth muscle cells and their contraction. An indirect mechanism of hypoxic vasoconstriction is the effect on the vascular wall of endogenous mediators such as leukotrienes, histamine, serotonin, angiotensin II and catecholamines, the production of which is significantly increased under conditions of hypoxia. Hypercapnia and acidosis also lead to vascular smooth muscle spasm, however, it is assumed that this is not due to direct vasoconstriction, but to an increase in cardiac output.

An important role in the formation of AH is played by endothelial dysfunction of various origins. Chronic hypoxemia leads to damage to the vascular endothelium, which is accompanied by a decrease in the production of relaxing factors, including prostacyclin, prostaglandin E2 and nitric oxide (NO). Special meaning

attached to insufficient synthesis of nitric oxide. The synthesis of endogenous NO is regulated by NO synthase, which is constantly expressed on endothelial cells. Hypoxemia leads to impaired NO production and release. It should be noted that endothelial dysfunction in patients with BA and COPD is associated not only with hypoxemia, but also with chronic inflammation. R. Zieche et al. showed that chronic inflammation leads to a significant decrease in NO synthase expression and, consequently, NO production.

The remodeling of the vessel walls, characterized by media proliferation, migration and proliferation of smooth muscle cells into the intima, intimal fibroelastosis, and thickening of the adventitia, also aggravates GB in patients with BLZ.

Polycythemia, which is a consequence of chronic arterial hypoxemia, is also a hypoxemia-independent factor leading to an increase in blood viscosity, resistance in the vascular bed, and an increase in pressure in the pulmonary artery. In addition, one cannot fail to mention the effect of a high amplitude of negative inspiratory intrathoracic pressure.

Be that as it may, patients suffering from HD and AD are a population of patients with two diseases that can reduce their quality of life and reduce its duration. Therefore, it is necessary to carry out adequate treatment of both diseases, rationally approaching the choice of basic therapy.

Treatment of patients with combined bronchopulmonary and cardiovascular pathology is one of the urgent problems of modern medical practice. It is well known that drugs used to treat AD have a negative effect on the cardiovascular system.

Thus, inhaled beta-2-agonists, which are essential drugs for patients with asthma, and used in extremely high doses during an exacerbation, contribute to an increase in systemic blood pressure.

Systemic glucocorticosteroids (GCS), which are the basis for the treatment of asthma exacerbations, according to the GINA global strategy for the treatment and prevention of asthma, have a direct vasoconstrictor effect and inevitably lead to aggravation of hypertension. In addition to a direct effect on vascular tone, the use of systemic corticosteroids causes fluid retention, an increase in body weight, which also leads to an increase in systemic blood pressure. At the same time, according to the consensus document, the dose of GCS recommended at the time of exacerbation is from 3 to 12 tablets per day in terms of prednisolone for a person weighing 60 kg (0.5-1 mg / kg).

In turn, drugs used to correct blood pressure can have an adverse effect on the biomechanics of respiration in general and the course of asthma in particular.

When deciding on the appointment of an antihypertensive drug in patients with asthma, several principles should be followed. The antihypertensive drug must meet the following requirements:

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No negative impact on bronchial conduction;

No clinically significant hypokalemia effect;

No cough effect;

No interaction with bronchodilators.

Moreover, the desired properties of an antihypertensive drug for patients with AD are:

Reducing pulmonary hypertension;

Decreased platelet aggregation;

Positive effect on the endothelium.

Representatives of many classes of antihypertensive

funds have a possible negative impact on the course of asthma.

Diuretics are one of the most common classes of antihypertensive drugs. They are distinguished by high efficacy, good tolerability, a proven positive effect on cardiovascular morbidity, low or moderate cost. The clinical value of diuretics when compared with new classes of antihypertensive drugs has been confirmed in a number of multicenter clinical trials. However, no randomized multicenter trials have been conducted on the treatment of hypertension in patients with asthma with drugs of this class.

Moreover, there is also a risk of adverse effects when using diuretics in patients with asthma. First of all, such effects include hypokalemia, which can negatively affect the work of the respiratory muscles, leading to the progression of respiratory failure, especially in patients with severe BLZ. The threat of hypokalemia increases with the combined use of diuretics and beta-2-agonists, which contribute to the entry of potassium into the cell, further reducing its concentration in the blood plasma. The use of systemic corticosteroids increases the excretion of potassium in the urine.

Another equally important side effect when using diuretics is blood clotting, especially in conditions of already existing secondary erythrocytosis. In addition, during diuretic therapy, metabolic alkalosis may develop, which in patients with severe asthma and COPD (with respiratory failure) can lead to respiratory center depression and deterioration of gas exchange.

These side effects are certainly more common with loop diuretics. Therefore, the use of thiazide derivatives becomes preferable in this case. However, even thiazide-like indapamide retard can lead to hypokalemia, and can also disrupt mucus production, worsening the rheological properties of sputum, which becomes especially important during periods of exacerbation of BLZ.

Thus, diuretics should be used with caution in the treatment of hypertension in patients with asthma.

Beta-blockers (BABs) are a large group of antihypertensive drugs with proven efficacy, safety, and positive effects.

ORIGINAL ARTICLE Volume 15, No. 1 / 2009

on life expectancy, especially in patients with complicated course of GB. They can be used as antihypertensive drugs both as monotherapy and in combination with diuretics, dihydropyridine calcium antagonists, angiotensin-converting enzyme (ACE) inhibitors. This group of drugs is the first line of antihypertensive drugs in the presence of angina, myocardial infarction, tachyarrhythmia, heart failure.

Given the presence of affinity for beta-2-adrenergic receptors, BAB, interacting competitively with the receptor, cause bronchospasm and interfere with the therapeutic effect of beta-2-agonists. The dose of the drug that can cause bronchospasm, as well as its severity, is almost impossible to predict. Sometimes sufficient for its development (even in patients with moderate asthma) may be the minimum amount of the drug (for example, eye drops containing beta-blockers used in the treatment of glaucoma).

Taking into account the known effect of BAB on beta-2 receptors of bronchial muscles, as well as their competitive interaction with beta-2-agonists, the use of this group of antihypertensive drugs for a long time was an absolute contraindication for use in patients suffering from obstructive pulmonary diseases, especially BA.

With the advent of selective BAB, the situation has changed somewhat. More and more evidence appears that the use of selective β-blockers in low doses is possible in patients with BA.

To address the issue of the possibility of using β-blockers in patients with BA, a number of multicenter randomized trials were carried out, the purpose of which was to evaluate the effect of selective and non-selective β-blockers on the parameters of lung function in patients with COPD and BA. Data from these studies over the past 20 years are presented in a meta-analysis by Cazzola et al. (2002).

Studies have shown that cardioselective β-blockers have different effects on the biomechanics of respiration. For example, according to Braat et al., atenolol to a lesser extent than metoprolol caused a change in peak expiratory flow rate (PEV), forced expiratory volume (FEV1), forced vital capacity (FVC) and other indicators.

It should be noted that according to the results of a meta-analysis conducted by Salpeter et al. (2002), most studies have studied the effect of β-blockers only on changes in FEV1 and response to the use of inhaled beta-2-agonists, while the effect on bronchial hyperreactivity in patients with COPD and BA is the subject of isolated studies, although pronounced bronchial hyperreactivity is associated with an increase in mortality in this category of patients. It should be noted that bronchial hyperreactivity in BA is significantly higher than in COPD with incompletely reversible bronchial obstruction, so the use of β-blockers as a therapy in patients with BA is an even more controversial issue.

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According to a meta-analysis by Cazzola et al. (2002), the lack of effect on airway patency and response to short-acting bronchodilators was leveled with increasing doses of the drug. This is due to the fact that the selectivity of drugs is not absolute, and cardioselective β-blockers also have an affinity for P-2 receptors, which manifests itself at a certain concentration of the drug. Moreover, the spread of the therapeutic selectivity index is individual and cannot be predicted in different patients.

Thus, the appointment of cardioselective β-blockers in patients with COPD is possible, and in patients with BA and uncomplicated hypertension, the use of drugs of this class should be avoided. Nevertheless, due to the positive impact on the life expectancy of patients with cardiovascular complications (especially myocardial infarction), as well as the ineffectiveness of the use of other groups of antihypertensive drugs, the use of cardioselective β-blockers in some cases is possible in patients with BA, but in low doses, starting with the minimum, and against the background of adequate inhalation basic therapy under the close supervision of a physician.

Angiotensin converting enzyme inhibitors (ACE inhibitors) have been successfully used for more than 20 years to correct hypertension in patients with various comorbidities. During this time, ACE inhibitors, despite the emergence of new groups of antihypertensive drugs, remain the first-line drugs in the treatment of hypertension. This is due to the fact that, according to studies, ACE inhibitors have important positive effects, which include: an effective decrease in blood pressure, a decrease in myocardial hypertrophy, a nephroprotective effect, an improvement in myocardial diastolic function, exercise tolerance, a positive effect on endothelial function, a decrease in oxidative stress and others. The use of ACE inhibitors significantly reduces the risk of recurrent myocardial infarction and recurrent acute cerebrovascular accident (CVA).

One of the side effects that limit the use of ACE inhibitors is cough. In addition to changing the metabolism of bradykinin, which is responsible for the appearance of this symptom, ACE inhibitors increase the concentration of other pro-inflammatory agents in the lung tissue - substance P and neurokinin A. This, in turn, leads to an increase in the level of prostaglandins I2, E2 Substance P itself, as well as prostaglandins, is a potential bronchoconstrictor and is suspected to be the neurochemical mediator that causes coughing. The appearance of cough is of particular importance in patients with bronchopulmonary pathology, as it is one of the key symptoms of the underlying disease.

Previously, it was believed that the use of ACE inhibitors in patients with BA not only contributes to the onset of cough, but can lead to aggravation of BA and even induce its development. However, according to recent studies, patients with comorbid

^ hypertension

obstructive pulmonary diseases are not a group of increased risk of developing cough or bronchial obstruction during ACE inhibitor therapy and the proportion of patients with the occurrence of cough is comparable to the general population. Despite this, the connection of the cough that has arisen with taking the drug in patients with BLZ remains unrecognized for a long time, is mistakenly interpreted by the patient and the doctor as an exacerbation of the disease and leads to an unreasonable increase in the dose of basic therapy.

It is very difficult to objectively assess the effect of ACE inhibitors on the course of asthma and COPD in randomized trials. Cough can develop weeks and even months after the start of ACE inhibitor therapy, and inhalation basic therapy (iGCS, P-agonists) can mask the clinical picture for a long time.

According to a meta-analysis by Cazzola et al. (2002), due to the insufficient number of controlled studies, a small sample of patients, insufficient duration of observation, data on the use of ACE inhibitors in concomitant COPD and BA are still very contradictory.

Recently, angiotensin II receptor antagonists (AT II) have been widely used in patients with intolerance to ACE inhibitors. Due to the lack of influence on the metabolism of bradykinin, there is no such side effect as coughing. However, their effectiveness in reducing blood pressure is somewhat lower compared to ACE inhibitors (possibly due to the absence of the effect of bradykinin). According to Cazzola et al. (2002), due to the lack of a sufficient number of controlled randomized trials, the appointment of AT II receptor antagonists for the treatment of hypertension in people with concomitant broncho-obstructive diseases meets the criterion of evidence C.

Calcium antagonists (CA) are a large class of antihypertensive drugs with a proven hypotensive effect and good tolerability. As you know, the group of calcium channel blockers is heterogeneous. There are two main groups of AKs: dihydropyridine (nifedipine, amlodipine and others) and non-dihydropyridine (verapamil, diltiazem).

AK for a long time are the means of choice for the correction of blood pressure in patients suffering from obstructive pulmonary diseases, in particular BA. They are antihypertensive drugs that are equally effective in people of different ages and races. They improve endothelial function, prevent the development of atherosclerosis of the coronary arteries, have a vasodilatory effect, reduce myocardial hypertrophy, and do not affect glucose levels and lipid metabolism.

Calcium channel blockers are the gold standard for the treatment of patients with a combination of hypertension and BLZ. This is due not only to the absence of a negative effect on the bronchial tree, but also to the fact that, according to a number of authors, AKs improve bronchial patency and reduce bronchial hyperreactivity. In a placebo-controlled study, Fogari et al. (1987)

hypertension

evaluated the effect of Isoptin SR on blood pressure and respiratory function in patients with hypertension and asthma. Measurements were taken immediately before prescribing the drug, and again, after 4 weeks of therapy. The results showed that Isoptin SR not only effectively reduced blood pressure, but also significantly (by 23%, p< 0,05) увеличивал ОФВ после ингаляции сальбутамолом в сравнении с группой плацебо (рис. 4).

Figure 4. Increase in forced expiratory volume in patients with bronchial asthma and arterial hypertension while receiving placebo or Isoptin SR

Placebo Verapamil

*Adapted from: Fogari R. et al, In: Fleckenstein A, Laragh JH (eds.) ‘Hypertension - The Next Decade: Verapamil in Focus’. Churchill Livingstone, Edinburgh, 1987, p. 229-232.

Notes: FEV - forced expiratory volume.

n = 17, duration of treatment was 4 weeks. In the Isoptin SR group after salbutamol inhalation, a significant increase in FEV was obtained compared with the placebo group. Before inhalation, there was no difference in FEV between the placebo and verapamil groups.

Data on a positive bronchodilatory effect are available for both verapamil and dihydropyridine AKs. To a lesser extent, diltiazem has the ability to bronchodilate. In addition, calcium channel blockers, according to Karpov Yu.A. et al. (2003), weak antiaggregant activity is inherent.

Dihydropyridine AKs have a hypotensive effect comparable to IFPAs and diuretics, but lead to an increase in heart rate, which is undesirable against the background of the use of bronchodilators. Therefore, Verapamil (Isoptin SR), which reduces elevated heart rate, is becoming the drug of choice for the treatment of hypertension in patients with COPD and asthma. In addition, experimental studies have shown the ability of verapamil to both prevent and reduce pre-existing bronchoconstriction that has developed in response to histamine exposure.

Pulmonary hypertension, characterized by a progressive increase in pulmonary vascular resistance, can lead to the development of right ventricular heart failure and premature death of patients. The development of pulmonary hypertension in COPD patients determines the appointment of AC as drugs of choice, because, along with hypotensive properties, they, according to some authors, have

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They have a possible bronchodilatory effect and the ability to reduce pressure in the pulmonary artery due to the expansion of the vessels of the small circle.

At the same time, high doses of this group of drugs, changing the ventilation-perfusion ratio due to the suppression of compensatory vasoconstriction, can lead to aggravation of arterial hypoxemia associated with dilatation of pulmonary vessels in poorly perfused areas of the lungs.

Given the possible positive effect of this group of antihypertensive drugs on bronchial patency and reactivity, the possibility of reducing the signs of pulmonary hypertension, a small number of side effects and good tolerability, according to the results of meta-analyses conducted by Cazzola et al. (2002) and Dart et al. (2003), AKs are a group of first-line antihypertensive drugs in the treatment of hypertension in patients with BL.

The data of the analysis of the sources of available literature showed the following:

1. The effectiveness of the use of diuretics in patients with a combination of hypertension and BA has not been proven, therefore, the drugs in this group are not first-line antihypertensive drugs for AH against the background of BA.

2. Cough (from slight to severe) in the appointment of an ACE inhibitor leads to an unreasonable increase in basic therapy and reduces the adherence of patients with BA and AH to antihypertensive treatment with ACE inhibitors.

3. BABs increase bronchial resistance and are not recommended as the choice of antihypertensive drug in patients with asthma. Only certain conditions (concomitant cardiac pathology) can be a reason to consider their possible appointment. If it is necessary to prescribe them (inefficiency of other classes of antihypertensive drugs, cardiac pathology requiring the appointment of BAB), cardioselective BAB should be prescribed under careful control of BA, not forgetting that the selectivity decreases with increasing dose of the drug.

4. According to a number of studies, AA reduce bronchial reactivity, pressure in the pulmonary artery, and are well tolerated. Non-dihydropyridine AKs (verapamil SR), in addition to the above effects, slow down the increased heart rate, which is important for patients with asthma and COPD taking adrenomimetics. Therefore, despite the limited amount of data on the use of this group of drugs in patients with asthma, AAs (primarily verapamil SR) remain the drugs of first choice for the treatment of hypertension in patients with asthma and COPD.

Thus, the treatment of patients with a combination of BA and HT is a difficult task and requires additional studies to assess the efficacy and safety of the use of various groups of drugs. Unfortunately, many antihypertensive drugs used in general practice have effects that limit their use in patients with bronchitis.

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obstructive diseases, in particular BA. Based on current clinical data, the most preferred for the control of blood pressure in patients with a combination of hypertension and asthma is the use of drugs of the AK class, mainly non-dihydropyridine series, such as Isoptin SR (verapamil in the form of a sustained release, pharmaceutical company Abbott).

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14. Chazova I.E. Arterial hypertension and chronic obstructive pulmonary disease. Consilium Medicum. 2006;8(5). [Electronic source] http://www.consilium-medicum.com.

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16. Guide for practitioners. //ed. acad. RAMN, prof. R.M. Khaitova. Moscow: MEDpress-inform; 2002. 624 p.

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18. Homa DM, Mannino DM, Lara M. Asthma Mortality in U.S. His-panics of Mexican, Puerto Rican, and Cuban Heritage, 1990-1995. American Journal of Respiratory and Critical Care Medicine. 2000;161:504-9.

19. Zodionchenko V.S., Adasheva T.V., Shilova E.V. et al. Clinical and functional features of arterial hypertension in patients with chronic obstructive pulmonary disease. breast cancer. 2003;9:535-8.

20 Avdeev S.N. Pulmonary hypertension in chronic obstructive pulmonary disease. Systemic hypertension. Supplement to Consilium Medicum. 2004;6(1). [Electronic source] http://www. consilium-medicum.com.

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23. Vonbank K, Ziesche R, Higenbottam TW, Stiebellehner L, Petkov V, Schenk P, et al. Controlled prospective randomized trial on the effects on pulmonary haemodynamics of ambulatory long term use of nitric oxide and oxygen in patients with severe COPD. Thorax. 2003;58:289-93.

24. Nakamura A, Kasamatsu N, Hashizume I, Shirai T, Hanzawa S, Momiki S, et al. Effects of hemoglobin on pulmonary arterial pressure and pulmonary vascular resistance in patients with chronic emphysema. Respiration. 2000;67:502-6.

25. Weitzenblum E., Chaouat A. Hypoxic pulmonary hypertension in man: what minimum daily duration of hypoxemia is required? Eur Respir J. 2001;18:251-3.

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Bronchial asthma is a chronic disease of the respiratory system of an infectious-allergic nature, which manifests itself in obstructive disorders of the bronchial lumen (that is, to put it more simply, in the narrowing of the airway lumen) and many cellular elements of a very different nature take part in this process, throwing out a large number of all kinds mediators - biologically active substances, which are the root cause of all these phenomena and, as a result, asthma attacks. Chronic cor pulmonale is a pathological condition that is characterized by a number of changes in the heart itself and blood vessels (the most basic are right ventricular hypertrophy and vascular changes). This is due mainly to hypertension of the pulmonary circulation. Also, after some time, arterial hypertension of a secondary nature develops (that is, an increase in pressure, the cause of which is reliably known). The question regarding pressure in bronchial asthma, the causes of its occurrence and the consequences of this phenomenon has always been relevant.

Regarding whether these two diseases are interconnected, there are two diametrically opposed points of view. One group of honored academicians and professors is of the opinion that one has never and will not affect the other in any way, another group of no less respected people is of the opinion that bronchial asthma is without fail the main causative factor in the development of chronic pulmonary heart, and as a result - secondary arterial hypertension. That is, according to this theory - all asthmatics in the future of hypertension.

What is most interesting, purely statistical data confirm the theory of those scientists who see bronchial asthma as the primary source of secondary arterial hypertension - with age, people with bronchial asthma experience an increase in blood pressure. It can be argued that hypertension (aka essential hypertension) is observed with age in every first person. Another point is that in asthmatics, an increase in blood pressure (persistent) is observed much earlier, and this causes much higher mortality and disability rates due to the occurrence of vascular accidents (myocardial infarction and hemorrhagic, ischemic strokes).

An important argument in favor of this particular concept will also be the fact that chronic cor pulmonale, and as a result, secondary arterial hypertension, develops in children and adolescents suffering from bronchial asthma. But are statistics confirmed at the level of physiology? The question is very serious, since by establishing the true etiology, pathogenesis and the relationship of this process with environmental factors, it is possible to develop an optimized treatment regimen.

The most intelligible answer on this subject was given by Professor V.K. Gavrisyuk from the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky. It is also important that this scientist is also a practicing doctor, and therefore his opinion, which is confirmed by numerous studies, may well claim not only a hypothesis, but also a theory. The essence of this teaching is given below.

In order to understand this whole problem, it is necessary to better understand the pathogenesis of the entire process. Chronic cor pulmonale develops only against the background of right ventricular failure, which, in turn, is formed due to increased pressure in the pulmonary circulation. Hypertension of the small circle is caused by hypoxic vasoconstriction - a compensatory mechanism, the essence of which is to reduce the provision of blood flow in the ischemic lobes of the lungs and the direction of blood flow to where gas exchange is intensive (the so-called West areas).

Cause and effect

It should be noted that for the formation of right ventricular failure with its hypertrophy and the subsequent formation of chronic cor pulmonale, the presence of persistent arterial hypertension is necessary. In bronchial asthma, even in the most severe form, there is no constant increase in pressure in the pulmonary vein and artery, and therefore it is somewhat wrong to consider this pathological mechanism as a whole etiological factor in secondary arterial hypertension in bronchial asthma.

In addition, there are a number of very important points. With the manifestation of transient arterial hypertension caused by an asthma attack in bronchial asthma, an increase in intrathoracic pressure is of decisive importance. This is a prognostically unfavorable phenomenon, since after a while the patient will be able to observe a pronounced swelling of the cervical veins, with all the ensuing adverse consequences (by and large, the symptoms of this condition will have a lot in common with pulmonary embolism, because the mechanisms of development of these pathological states are very similar).

Scheme of the formation of a vicious circle.

Due to an increase in intrathoracic pressure and a decrease in venous return of blood to the heart, stagnation occurs in the basin of both the inferior and superior vena cava. The only adequate help in this condition will be the relief of bronchospasm by the methods that are used in bronchial asthma (beta2-agonists, glucocorticoids, methylxanthines) and massive hemodilution (infusion therapy).

From all of the above, it becomes clear that hypertension is not a consequence of bronchial asthma as such, for the simple reason that the resulting increase in pressure in the small circle is intermittent and does not lead to the development of chronic cor pulmonale.

Another question is other chronic diseases of the respiratory system that cause persistent hypertension in the pulmonary circulation. First of all, these include chronic obstructive pulmonary disease (COPD), many other diseases that affect the lung parenchyma, such as scleroderma or sarcoidosis. In this case, yes, their participation in the occurrence of arterial hypertension is fully justified.

An important point is the damage to the tissues of the heart due to oxygen starvation, which occurs during an attack of bronchial asthma. In the future, this may play a role in the increase in pressure (persistent), however, the contribution of this process will be very, very insignificant.

In a small number of asthma sufferers (about twelve percent) there is a secondary increase in blood pressure, which, one way or another, is interconnected with a violation of the formation of polyunsaturated arachidonic acid, associated with an excessive release of thromboxane-A2, some prostaglandins and leukotrienes into the blood. This phenomenon is caused, again, by a decrease in the supply of oxygen to the blood to the patient. However, a more significant reason is the prolonged use of sympathomimetics and corticosteroids. Fenoterol and salbutamol have an extremely negative effect on the state of the cardiovascular system in bronchial asthma, because in high doses they significantly affect not only beta2-adrenergic receptors, but are also able to stimulate beta1-adrenergic receptors, significantly increasing the heart rate (causing persistent tachycardia) , thereby increasing myocardial oxygen demand, increasing the already pronounced hypoxia.

Also, methylxanthines (theophylline) have a negative effect on the functioning of the cardiovascular system. With constant use, these drugs can lead to severe arrhythmias, and as a result, to disruption of the heart and subsequent arterial hypertension.

Systematically used glucocorticoids (especially those that are used systemically) also have an extremely bad effect on the state of the vessels - due to their side effect, vasoconstriction.

The tactics of managing patients with bronchial asthma, which will reduce the risk of developing such complications in the future.

The most important thing is to consistently adhere to the course of treatment prescribed by a pulmonologist against bronchial asthma and avoid contact with the allergen. After all, the treatment of bronchial asthma is carried out according to the Jin protocol, developed by the world's leading pulmonologists. It is in it that a rational stepwise therapy of this disease is proposed. That is, at the first stage of this process, seizures are observed very rarely, no more than once a week, and they stop with a single dose of ventolin (salbutamol). By and large, provided that the patient adheres to the course of treatment and leads a healthy lifestyle, excludes contact with the allergen, the disease will not progress. No hypertension will develop from such doses of ventolin. But our patients, for the most part, are irresponsible people, they do not adhere to treatment, which leads to the need to increase the dosage of drugs, the need to add other groups of drugs to the treatment regimen with much more pronounced side effects due to the progression of the disease. All this then turns into an increase in pressure, even in children and adolescents.

It is worth noting the fact that the treatment of this kind of arterial hypertension is many times more difficult than the treatment of classical essential hypertension, in view of the fact that a lot of effective drugs cannot be used. The same beta-blockers (let's take the latest - nebivolol, metoprolol) - despite all their high selectivity, they still affect the receptors located in the lungs and may well lead to status asthmaticus (silent lung), in which ventolin is no longer exactly will help, in view of the lack of sensitivity to it.
Although all of the above consequences in chronic obstructive bronchitis are much more pronounced and entail much more severe consequences that are incomparable with those described in this article. But that is a completely different story.

X-ray of a patient with severe pulmonary hypertension. The numbers indicate the foci of ischemia.

Outcome

From all of the above, the following conclusions can be drawn:

Bronchial asthma itself can cause arterial hypertension, but this happens in a small number of patients, as a rule, with improper treatment, accompanied by a large number of attacks of bronchial obstruction. And then, it will be an indirect effect, through trophic disorders of the myocardium.
A more serious cause of secondary hypertension would be other chronic diseases of the respiratory tract (chronic obstructive pulmonary disease (COPD), many other diseases affecting the lung parenchyma, such as scleroderma or sarcoidosis).
The main cause of the onset of hypertension in asthmatics is the drugs that treat bronchial asthma itself.
The systematic implementation by the patient of the prescribed treatment regimens and other recommendations of the attending physician is a guarantee (but not one hundred percent) that the process will not progress, and if it does, it will be much slower. This will allow you to keep the therapy at the level that was originally prescribed, not to prescribe stronger drugs, the side effects of which will not lead to the formation of arterial hypertension in the future.

Video: Elena Malysheva. Chronic cough and bronchial asthma

A number of concomitant diseases require correction of drug therapy of the underlying pathology. Arterial hypertension in bronchial asthma is a fairly common occurrence. Therefore, it is important for the doctor and the patient to know which drugs are contraindicated in the combined course of these diseases. Compliance with simple rules will help to avoid complications and save the patient's life.

Where is the link between pathologies?

Bronchial asthma is a chronic inflammation of the upper respiratory tract, which is accompanied by bronchospasm. Patients suffering from this disease often have autonomic dysfunctions. And the latter in some cases become the cause of arterial hypertension. That is why both diseases are pathogenetically related. In addition, an increase in blood pressure is a symptom of bronchial asthma, in which the body suffers from a lack of oxygen, which in a smaller amount enters the lungs through a narrowed airway. In order to compensate for hypoxia, the cardiovascular system increases the pressure in the bloodstream, trying to provide organs and systems with the necessary amount of oxygenated blood.

Why does the patient's blood pressure rise?

The cause of increased systolic and diastolic blood pressure is an increase in the resistance of peripheral vessels and an increase in the pumping function of the myocardium. These are compensatory reactions to oxygen deficiency. In older people, hypertension is a disease that provokes the deposition of atherosclerotic plaques in the vascular walls. But in younger patients, it can occur as a direct consequence of chronic asthma attacks. In patients with long-term asthma, the so-called "cor pulmonale" is formed. It is characterized by hypertrophy of the right ventricle - an increase in its mass and expansion of the cavities.

"Pulmonary heart" loses the ability to redistribute blood through the main vessels, resulting in increased pressure in the pulmonary circulation. This phenomenon is called.

Asthmatic and hypertensive symptoms

Cough can be a manifestation of both pathologies at once.

In the presence of a combination of these two pathologies, the following clinical symptoms develop:

Dyspnea. More often it is expiratory in nature. It is more difficult for the patient to exhale than to inhale. The act of breathing in him occurs with the presence of a specific whistle - wheezing.
Cyanosis of the nasolabial triangle and fingertips. This symptom appears as a result of insufficient blood supply to the distal parts of the body.
Cough with a small amount of clear sputum. If there is a layering of a bacterial infection, the discharge becomes yellow or green.
Headache. It often occurs against the background of high blood pressure and is accompanied by mild neurological abnormalities.
Pressure in chest. It is angina pectoris in nature and is provoked by bronchospasm.
Increased symptoms in response to external factors - physical activity, weather changes.
General weakness. It is caused by oxygen starvation of organs and tissues.
Ringing in the ears and flies before the eyes. These phenomena also cause oxygen deficiency.

Treatment of hypertension in bronchial asthma. Why does blood pressure rise in asthma?

Signs of increased blood pressure

Drugs for hypertension and bronchial asthma

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Pressure medications that do not cause coughing

pressure pills for asthma

What cough pills increase blood pressure

Does broncholithin increase blood pressure?

Cough as a side effect of blood pressure pills

Useful video

What is the relationship between diseases?

Types of hypertension

Course of the disease

Features of the treatment of hypertension in asthma

Medicines for hypertension in bronchial asthma

How to lower the pressure?

Norms of indicators

How to lower high blood pressure

Medical preparations

Non-pharmacological ways to solve the problem

What foods can help lower blood pressure

How to quickly bring down the pressure?

Pressure drugs that do not cause cough: what to do when taking

Types of drugs for pressure

What blood pressure medications cause coughing?

What medications are safest to use for hypertension?

What is the electrical axis of the heart?

The range of position of the electrical axis is normal

How to determine the position of the electrical axis

Causes of deviations from the norm

Symptoms

Diagnostics

Treatment

Cause and effect

Outcome

Video: Elena Malysheva. Chronic cough and bronchial asthma

Where is the link between pathologies?

Why does the patient's blood pressure rise?

Asthmatic and hypertensive symptoms

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