We ready a two-part review of the English-language literature pertaining to put drugs into therapy for systemic high BP in patients with pulmonary diseases.

We ready a two-part review of the English-language literature pertaining to put drugs into therapy for systemic high BP in patients with pulmonary diseases. Part I examines the literature pertaining to the use of antihypertensive physics in patients with systemic hypertension and coexisting pulmonary conditions, especially COPD and asthma. Part II of the series reviews studies assessing the relationship between sleep-disordered breathing (including the part of the sympathetic nervous system) and systemic hypertension, and at hands an approach to the management of these patients. It is the aim of the couple parts of this review to make qualified conclusions and recommendations applying a methodologic critique to assess the common literature. In the first part of this series, we review the demographics of hypertension in patients with COPD This is followed on an extensive review of the use of specific classes of antihypertensive unsalable article therapies in patients with pulmonary disease. The antihypertensive agents reviewed include diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists, [beta]-adrenergic blocking agents, and [alpha]-[beta]-blockers and other non-[beta]-blocker classes. Additionally, the renin angiotensin hypothesis is briefly reviewed, with a discussion of to what extent angiotensin-converting enzyme inhibitors induce cough especially in pulmonary and congestive heart failure patients.

explanation words: antihypertensive drugs; asthma; COPD; pulmonary disease; systemic high BP

Abbreviations: JNC VI = Sixth Report of the Joint National Committee upon Prevention, Detection, Evaluation and Treatment of High BP; PEFR = peak expiratory result rate; SDB = sleep-disordered breathing

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Treatment of patients with systemic hypertension is repeatedly complicated by the coexistence of chronic pulmonary disease and sleep-disordered breathing (SDB) The latter can itself exacerbate systemic hypertension, and certain antihypertensive mix with drugss can affect pulmonary function. like patients present diagnostic and therapeutic challenges. A wide variety of antihypertensive mix with drugss are now available with different mechanisms of action. This raises questions, similar as whether agents that induce bronchospasm should for aye be used to treat hypertension in patients with asthma or SDB What is the physiology behind the physic effects? What alternative classes of remedys have been tested in clinical settings and should be considered in a less degree than specific circumstances? What type of medical history readys caution in the use of these agents? The American literary institution [i]or[/i] seminary of learning of Chest Physicians charged this panel to escort a systematic and critical review of the literature and summarize relevant recommendations and conclusions regarding the following: (1) antihypertensive put drugs into therapy in patients with chronic pulmonary disease, and (2) SDB as a causative or contributory factor in systemic hypertension.

In the first part of this series, we review the demographics of hypertension in patients with COPD This is followed at an extensive review of the use of specific classes of antihypertensive unsalable article therapies in patients with pulmonary disease. The antihypertensive agents reviewed include diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists, [beta]-adrenergic blocking agents, and [alpha]-[beta]-blockers and other non-[beta]-blocker classes. Additionally, the renin angiotensin body is briefly reviewed, with a discussion of by what means angiotensin-converting enzyme inhibitors induce cough especially in pulmonary and congestive heart failure patients. Findings and recommendations are currented Patient evaluation and diagnosis were not a part of this review. SDB issues will be hideed in Part II of this series.

MATERIALS AND METHODS

The rationale used for searching the literature, selecting relevant articles, and grading evidence for this article are described in the Appendix.

Database Searches

For this review, the PubM database was systematically searched for articles published between 1972 and 2000 using [i]clavis[/i] words and the medical subdue heading terms to identify studies. of that kind studies were considered relevant if they addressed asthma, COPD lung diseases, pulmonary disease, hypertension, arterial hypertension, and/or systemic hypertension. the one and the other medical subject headings and keywords were used in searches, owed to concerns about potential accuracy of National Library of Medicine indexing. Additional comodifying denominations included names of classes of antihypertensive put drugs intos and various permutations on class names: [beta]-adrenergic receptor blocker [beta]-blockers, [[beta].sub.1]-blockers, [[beta].sub.2]-blockers, [beta]-adrenergic antagonists, sympathetic inhibitors, adrenergic antagonists, [beta]-receptor antagonists, central [alpha]-adrenergic blocker calcium channel blocker acetylcholinesterase inhibitors, and [alpha]-[beta]-blockers.

Inclusion/Exclusion Criteria

barely randomized or nonrandomized control trials, observational, sway cohort (longitudinal), case control, cros sectional, uncontroll case series/cohort, time series, cross-cultural, ecologic, descriptive epidemiologic, and case reports were included. The literature search exclud pulmonary hypertension, editorials, position papers, editorial opinions, abstracts, and epistles to the editor. Exceptions to this behavior were editorials, position papers, editorial opinions or notes to the editor that provided additional concerns thought to be of relevance and not build in the original search. We also chose not to review unpublished evidence.

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