Hypertension in chronic obstructive pulmonary disease (COPD): A review of current practice

Background: Patients with COPD are susceptible to cardiovascular events and a recent review article has outlined management of Hypertension in the COPD population [Finks S et al. N Engl J Med 2020;382:353-63]. It is not known how the authors’ suggestions translate into practice, so review was undertaken of a UK District General Hospital population. Aims: The aim was to review management of hypertensive COPD patients; choice of anti-hypertensive medication, and correlations with morbidity and mortality Methods: This was a retrospective analysis of all COPD patients who presented to hospital with an exacerbation between October and December 2019. Patients without a history of hypertension were excluded. Results: 151 patients were admitted during this period. 71/151 were known hypertension. 52% were female, Mean Age (SD) 74 (10) years. 83% (n=59/71) were on anti-hypertensive medication/s (AH) of which 44% (n=26/59), 42% (n=25/59), 12% (7/59) and 2% (1/59) were on one, two, three and four AH respectively. 42% (30/71) patients had an exacerbation in the last 12 months and 97% (29/30) were on ≥1 AH. Unadjusted 30 day mortality was 11% (n=8/71) of which 88% (7/8) were on ≥1 AH. n=2/3 patients on beta blockers, n=2/5 on angiotensin receptor blockers (ARB), n=6/12 on calcium channel blockers (CCB), n=3/4 on ACE-inhibitors and 1/1 on Alpha blocker as a single AH had an exacerbation in the last 12 months. More patients on loop diuretics (LD) had chronic type 2 respiratory failure (n=5) or exacerbations in the last 12 months (n=10). Conclusions: CCB is the most commonly used AH agent Patients on ARBs were least likely to exacerbate LD may contribute to more exacerbations and chronic type 2 respiratory failure