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Fluid and Electrolyte Considerations in Diuretic Therapy for Hypertensive Patients With Chronic Obstructive Pulmonary Disease

Fluid and Electrolyte Considerations in Diuretic Therapy for Hypertensive Patients With Chronic... Abstract When a patient with chronic obstructive pulmonary disease (COPD) requires medical therapy for systemic hypertension, a number of special considerations may affect the choice of antihypertensive drug and subsequent management. Thiazide diuretics have no adverse effect on airway function and are the agents of choice for initial therapy. β-Antagonists are usually considered first-line agents in antihypertensive therapy, but even relatively cardioselective ones may increase airway resistance in patients with obstructive lung diseases, and they should be used with caution, if at all, in such patients. Although potassium-wasting diuretics are the preferred agents for treating hypertension in patients with COPD, they may worsen carbon dioxide retention in hypoventilating patients and potentiate hypokalemia in those receiving corticosteroids. In addition, β-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassiumwasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or β-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents. (Arch Intern Med 1986;146:129-133) References 1. Metzner HL, Carman WJ, House J: Health practices, risk factors and chronic disease in Tecumseh. Prev Med 1983;12:491-507.Crossref 2. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1984;144:1045-1057.Crossref 3. Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: Reduction of mortality in persons with high blood pressure, including mild hypertension. JAMA 1979;242:2562-2571.Crossref 4. Light RW, Chetty KG, Stansbury DW: Comparison of the effects of labetalol and hydrochlorothiazide on the ventilatory function of hypertensive patients with mild chronic obstructive pulmonary disease. Am J Med 1983;75( (suppl 4A) ):109-114.Crossref 5. Lawrence DS, Sahay JN, Chatterjee SS, et al: Asthma and betablockers. Eur J Clin Pharmacol 1982;22:501-509.Crossref 6. Nies AS: Clinical pharmacology of antihypertensive drugs. Med Clin North Am 1977;61:675-698. 7. Odlind B: Site and mechanism of action of diuretics. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):5-15.Crossref 8. Kokko JP: Site and mechanism of action of diuretics. Am J Med 1984;77( (suppl 5A) ):11-17.Crossref 9. Perez-Stable E, Caralis PV: Thiazide-induced disturbances in carbohydrate, lipid, and potassium metabolism. Am Heart J 1983;106:245-251.Crossref 10. Knochel JP: Diuretic-induced hypokalemia. Am J Med 1984;77( (suppl 5A) ):18-27.Crossref 11. Griffing GT, Sindler BH, Aurecchia SA, et al: The effects of hydrochlorothiazide on the renin-aldosterone system. Metabolism 1983;32: 197-201.Crossref 12. Kochar MS, Itskovitz HD: Effects of hydrochlorothiazide in hypertensive patients and the need for potassium supplementation. Curr Ther Res 1973;15:298-304. 13. Kaplan NM: Our appropriate concern about hypokalemia. Am J Med 1981;77:1-4.Crossref 14. Hollifield JW: Potassium and magnesium abnormalities: Diuretics and arrhythmias in hypertension. Am J Med 1984;77( (suppl 5A) ):28-32.Crossref 15. Ferguson RK, Turek DM, Rovner DR: Spironolactone and hydrochlorothiazide in normal-renin and low-renin essential hypertension. Clin Pharmacol Ther 1977;21:62-69. 16. Ramsay LE, Hettiarachchi J, Fraser R, et al: Amiloride, spironolactone, and potassium chloride in thiazide-treated hypertensive patients. Clin Pharmacol Ther 1980;27:533-543.Crossref 17. Jackson PR, Ramsay LE, Wakefield V: Relative potency of spironolactone, triamterene and potassium chloride in thiazide-induced hypokalemia. Br J Clin Pharmacol 1982;14:257-263.Crossref 18. Schwartz WB, Brackett NC Jr, Cohen JJ: The response of extracellular hydrogen ion concentration to graded degrees of chronic hypercapnia: The physiologic limits of the defense of pH. J Clin Invest 1965;44: 291-301.Crossref 19. Turino GM, Goldring RM, Heinemann HO: Water, electrolytes and acid-base relationships in chronic cor pulmonale. Prog Cardiovasc Dis 1970;12:467-483.Crossref 20. Fowler N: Modern treatment of cardiac arrhythmias: A perspective , in Fowler N (ed): Cardiac Arrhythmias, Diagnosis and Treatment , ed 2. New York, Harper & Row Publishers Inc, 1977, p 2. 21. Haynes RC Jr, Murad F: Adrenocorticotropic hormone: Adrenocortical steroids and their synthetic analogs: Inhibitors of adrenocortical steroid biosynthesis , in Gilman AS, Goodman LS, Gilman A (eds): The Pharmacologic Basis of Therapeutics , ed 6. New York, Macmillan Publishing Co Inc, 1980, chap 63. 22. Adams JS, Wahl TO, Lukert BP: Effects of hydrochlorothiazide and dietary sodium restriction on calcium metabolism in corticosteroid-treated patients. Metabolism 1981;30:217-221.Crossref 23. Grospietsch G, Fenske M, Dietrich B, et al: Effects of the tocolytic agent fenoterol on body weight, urine excretion, blood hematocrit, hemoglobin, serum protein, and electrolyte levels in non-pregnant rabbits. Am J Obstet Gynecol 1982;143:667-672. 24. Berl T, Cadnapaphornchai P, Harbottle JA, et al: Mechanism of stimulation of vasopressin release during beta-adrenergic stimulation with isoproterenol. J Clin Invest 1974;53:857.Crossref 25. Stubblefield PG: Pulmonary edema occurring after therapy with dexamethasone and terbutaline for premature labor: A case report. Am J Obstet Gynecol 1978;132:341-342. 26. D'Silva JL: The action of adrenaline on serum potassium. J Physiol 1934;82:393-398. 27. Conci F, Procaccio F, Boselli L: Hypokalemia from beta2-receptor stimulation by epinephrine. N Engl J Med 1984;310:1329.Crossref 28. Brown MJ, Brown DL, Murphy MB: Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med 1983;309: 1414-1419.Crossref 29. Kung M, White JR, Burki NK: The effect of subcutaneously administered terbutaline on serum potassium in asymptomatic adult asthmatics. Am Rev Respir Dis 1984;129:329-332. 30. Montoliu J, Martinez-Vea A, Lopez-Pedret J, et al: Hypokalemia from beta2-receptor stimulation by epinephrine. N Engl J Med 1984;310:1329-1330.Crossref 31. Struthers AD, Whitesmith R, Reid JL: Prior thiazide diuretic treatment increases adrenaline-induced hypokalemia. Lancet 1983;1:1358-1361.Crossref 32. Vick RL, Todd EP, Luedke DW: Epinephrine-induced hypokalemia: Relation to liver and skeletal muscle. J Pharmacol Exp Ther 1972;181: 139-146. 33. Wester PO, Dyckner T: Problems with potassium and magnesium in diuretic-treated patients. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):59-65.Crossref 34. Harrington JT, Isner JM, Kassirer JP: Our national obsession with potassium. Am J Med 1982;73:155-159.Crossref 35. Multiple Risk Factor Intervention Trial Research Group: Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982;248:1465-1477.Crossref 36. Wester PO, Dyckner T: Diuretic treatment and magnesium losses. Acta Med Scand Suppl 1981;647:145-152. 37. Flink EB: Magnesium deficiency: Etiology and clinical spectrum. Acta Med Scand Suppl 1981;647:125-137. 38. Dhingra S, Solven F, Wilson A, et al: Hypomagnesemia and respiratory muscle power. Am Rev Respir Dis 1984;129:497-498. 39. Persson S: Potassium supplements or potassium sparing agents. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):107-113.Crossref 40. Walker BR, Hoppe RC, Alexander F: Effect of triamterene on the renal clearance of calcium, magnesium, phosphate, and uric acid in man. Clin Pharmacol Ther 1972;13:245-250. 41. Benson MK, Berrill WT, Cruickshank JM, et al: A comparison of four β-adrenoreceptor antagonists in patients with asthma. Br J Clin Pharmacol 1978;5:415-419.Crossref 42. Müller RB, Bolli P, Erne P, et al: Use of calcium antagonists as monotherapy in the management of hypertension. Am J Med 1984;77:11-15.Crossref 43. Corsis PA, Nariman S, Gibson GJ: Nifedipine in the prevention of asthma induced by exercise and histamine. Am Rev Respir Dis 1983;128: 991-992. 44. Anavekar SN, Barter C, Adam WR, et al: A double-blind comparison of verapamil and labetalol on hypertensive patients with coexisting chronic obstructive airway disease. J Cardiovasc Pharmacol 1982;4:S374-S377.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Fluid and Electrolyte Considerations in Diuretic Therapy for Hypertensive Patients With Chronic Obstructive Pulmonary Disease

Archives of Internal Medicine , Volume 146 (1) – Jan 1, 1986

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360130159022
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Abstract

Abstract When a patient with chronic obstructive pulmonary disease (COPD) requires medical therapy for systemic hypertension, a number of special considerations may affect the choice of antihypertensive drug and subsequent management. Thiazide diuretics have no adverse effect on airway function and are the agents of choice for initial therapy. β-Antagonists are usually considered first-line agents in antihypertensive therapy, but even relatively cardioselective ones may increase airway resistance in patients with obstructive lung diseases, and they should be used with caution, if at all, in such patients. Although potassium-wasting diuretics are the preferred agents for treating hypertension in patients with COPD, they may worsen carbon dioxide retention in hypoventilating patients and potentiate hypokalemia in those receiving corticosteroids. In addition, β-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassiumwasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or β-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents. (Arch Intern Med 1986;146:129-133) References 1. Metzner HL, Carman WJ, House J: Health practices, risk factors and chronic disease in Tecumseh. Prev Med 1983;12:491-507.Crossref 2. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1984;144:1045-1057.Crossref 3. Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: Reduction of mortality in persons with high blood pressure, including mild hypertension. JAMA 1979;242:2562-2571.Crossref 4. Light RW, Chetty KG, Stansbury DW: Comparison of the effects of labetalol and hydrochlorothiazide on the ventilatory function of hypertensive patients with mild chronic obstructive pulmonary disease. Am J Med 1983;75( (suppl 4A) ):109-114.Crossref 5. Lawrence DS, Sahay JN, Chatterjee SS, et al: Asthma and betablockers. Eur J Clin Pharmacol 1982;22:501-509.Crossref 6. Nies AS: Clinical pharmacology of antihypertensive drugs. Med Clin North Am 1977;61:675-698. 7. Odlind B: Site and mechanism of action of diuretics. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):5-15.Crossref 8. Kokko JP: Site and mechanism of action of diuretics. Am J Med 1984;77( (suppl 5A) ):11-17.Crossref 9. Perez-Stable E, Caralis PV: Thiazide-induced disturbances in carbohydrate, lipid, and potassium metabolism. Am Heart J 1983;106:245-251.Crossref 10. Knochel JP: Diuretic-induced hypokalemia. Am J Med 1984;77( (suppl 5A) ):18-27.Crossref 11. Griffing GT, Sindler BH, Aurecchia SA, et al: The effects of hydrochlorothiazide on the renin-aldosterone system. Metabolism 1983;32: 197-201.Crossref 12. Kochar MS, Itskovitz HD: Effects of hydrochlorothiazide in hypertensive patients and the need for potassium supplementation. Curr Ther Res 1973;15:298-304. 13. Kaplan NM: Our appropriate concern about hypokalemia. Am J Med 1981;77:1-4.Crossref 14. Hollifield JW: Potassium and magnesium abnormalities: Diuretics and arrhythmias in hypertension. Am J Med 1984;77( (suppl 5A) ):28-32.Crossref 15. Ferguson RK, Turek DM, Rovner DR: Spironolactone and hydrochlorothiazide in normal-renin and low-renin essential hypertension. Clin Pharmacol Ther 1977;21:62-69. 16. Ramsay LE, Hettiarachchi J, Fraser R, et al: Amiloride, spironolactone, and potassium chloride in thiazide-treated hypertensive patients. Clin Pharmacol Ther 1980;27:533-543.Crossref 17. Jackson PR, Ramsay LE, Wakefield V: Relative potency of spironolactone, triamterene and potassium chloride in thiazide-induced hypokalemia. Br J Clin Pharmacol 1982;14:257-263.Crossref 18. Schwartz WB, Brackett NC Jr, Cohen JJ: The response of extracellular hydrogen ion concentration to graded degrees of chronic hypercapnia: The physiologic limits of the defense of pH. J Clin Invest 1965;44: 291-301.Crossref 19. Turino GM, Goldring RM, Heinemann HO: Water, electrolytes and acid-base relationships in chronic cor pulmonale. Prog Cardiovasc Dis 1970;12:467-483.Crossref 20. Fowler N: Modern treatment of cardiac arrhythmias: A perspective , in Fowler N (ed): Cardiac Arrhythmias, Diagnosis and Treatment , ed 2. New York, Harper & Row Publishers Inc, 1977, p 2. 21. Haynes RC Jr, Murad F: Adrenocorticotropic hormone: Adrenocortical steroids and their synthetic analogs: Inhibitors of adrenocortical steroid biosynthesis , in Gilman AS, Goodman LS, Gilman A (eds): The Pharmacologic Basis of Therapeutics , ed 6. New York, Macmillan Publishing Co Inc, 1980, chap 63. 22. Adams JS, Wahl TO, Lukert BP: Effects of hydrochlorothiazide and dietary sodium restriction on calcium metabolism in corticosteroid-treated patients. Metabolism 1981;30:217-221.Crossref 23. Grospietsch G, Fenske M, Dietrich B, et al: Effects of the tocolytic agent fenoterol on body weight, urine excretion, blood hematocrit, hemoglobin, serum protein, and electrolyte levels in non-pregnant rabbits. Am J Obstet Gynecol 1982;143:667-672. 24. Berl T, Cadnapaphornchai P, Harbottle JA, et al: Mechanism of stimulation of vasopressin release during beta-adrenergic stimulation with isoproterenol. J Clin Invest 1974;53:857.Crossref 25. Stubblefield PG: Pulmonary edema occurring after therapy with dexamethasone and terbutaline for premature labor: A case report. Am J Obstet Gynecol 1978;132:341-342. 26. D'Silva JL: The action of adrenaline on serum potassium. J Physiol 1934;82:393-398. 27. Conci F, Procaccio F, Boselli L: Hypokalemia from beta2-receptor stimulation by epinephrine. N Engl J Med 1984;310:1329.Crossref 28. Brown MJ, Brown DL, Murphy MB: Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med 1983;309: 1414-1419.Crossref 29. Kung M, White JR, Burki NK: The effect of subcutaneously administered terbutaline on serum potassium in asymptomatic adult asthmatics. Am Rev Respir Dis 1984;129:329-332. 30. Montoliu J, Martinez-Vea A, Lopez-Pedret J, et al: Hypokalemia from beta2-receptor stimulation by epinephrine. N Engl J Med 1984;310:1329-1330.Crossref 31. Struthers AD, Whitesmith R, Reid JL: Prior thiazide diuretic treatment increases adrenaline-induced hypokalemia. Lancet 1983;1:1358-1361.Crossref 32. Vick RL, Todd EP, Luedke DW: Epinephrine-induced hypokalemia: Relation to liver and skeletal muscle. J Pharmacol Exp Ther 1972;181: 139-146. 33. Wester PO, Dyckner T: Problems with potassium and magnesium in diuretic-treated patients. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):59-65.Crossref 34. Harrington JT, Isner JM, Kassirer JP: Our national obsession with potassium. Am J Med 1982;73:155-159.Crossref 35. Multiple Risk Factor Intervention Trial Research Group: Multiple risk factor intervention trial: Risk factor changes and mortality results. JAMA 1982;248:1465-1477.Crossref 36. Wester PO, Dyckner T: Diuretic treatment and magnesium losses. Acta Med Scand Suppl 1981;647:145-152. 37. Flink EB: Magnesium deficiency: Etiology and clinical spectrum. Acta Med Scand Suppl 1981;647:125-137. 38. Dhingra S, Solven F, Wilson A, et al: Hypomagnesemia and respiratory muscle power. Am Rev Respir Dis 1984;129:497-498. 39. Persson S: Potassium supplements or potassium sparing agents. Acta Pharmacol Toxicol 1984;54( (suppl 1) ):107-113.Crossref 40. Walker BR, Hoppe RC, Alexander F: Effect of triamterene on the renal clearance of calcium, magnesium, phosphate, and uric acid in man. Clin Pharmacol Ther 1972;13:245-250. 41. Benson MK, Berrill WT, Cruickshank JM, et al: A comparison of four β-adrenoreceptor antagonists in patients with asthma. Br J Clin Pharmacol 1978;5:415-419.Crossref 42. Müller RB, Bolli P, Erne P, et al: Use of calcium antagonists as monotherapy in the management of hypertension. Am J Med 1984;77:11-15.Crossref 43. Corsis PA, Nariman S, Gibson GJ: Nifedipine in the prevention of asthma induced by exercise and histamine. Am Rev Respir Dis 1983;128: 991-992. 44. Anavekar SN, Barter C, Adam WR, et al: A double-blind comparison of verapamil and labetalol on hypertensive patients with coexisting chronic obstructive airway disease. J Cardiovasc Pharmacol 1982;4:S374-S377.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1986

References