The Effects of Hypertension Medications on Asthma

Having asthma puts you at an increased risk for high blood pressure (hypertension), which must be treated as it can lead to heart attack, stroke, and kidney failure, as well as severe asthma complications. But using drugs to do that is complicated. Some blood pressure medications (antihypertensives) can worsen asthma by causing the airways in the lungs to narrow.

Woman taking antihypertensive medication
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Antihypertensives fall into several categories:

  • Non-selective beta-blockers
  • Selective beta-blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Diuretics
  • Calcium channel blockers

What your doctor prescribes is based on a number of factors, including your age, your other medical issues, allergies, and potential interactions with your other prescriptions.

If you have asthma, they will choose an antihypertensive that both allows you to get good control of your hypertension without affecting your asthma or interfering with its treatment.

Beta-blockers and angiotensin-converting enzyme (ACE) inhibitors are the most likely to cause you to experience respiratory problems. And diuretics, which are safe for people with asthma, may exacerbate the side effects of some asthma medications.

Safe for Asthma
  • Angiotensin receptor blockers (ARBs)

  • Calcium channel blockers

  • Diuretics*

May Worsen Asthma
  • Non-selective beta-blockers

  • Beta-1-selective beta-blockers

  • ACE inhibitors

*May need to monitor potassium level

Non-Selective Beta-Blockers

Beta-blockers are used to treat high blood pressure because they block beta receptors on the blood vessels to help them widen.

But non-selective beta-blockers are just that—non-selective. Because you have beta receptors in your lungs as well, these drugs can also block beta receptors on respiratory passages and irritate the airways if you have asthma. This causes them to constrict, which leads to shortness of breath and wheezing.

For this reason, if you are prescribed a non-selective beta-blocker when you have asthma, your medical team may carefully monitor your respiratory function and your asthma symptoms.

Examples of non-selective beta-blockers include:

  • Inderal (propranolol)
  • Corgard (nadolol)
  • Betapace (sotalol)
  • Levatol (penbutolol)

Beta-1-Selective Beta Blockers

Two types of beta receptors are highly prevalent in the body. Beta-1 receptors are found in the heart and blood vessels, while beta-2 receptors are found in the lungs.

Because they don't have a strong effect on the airways, beta-1 selective blockers are considered safer than non-selective beta-blockers for people who have asthma.

Examples of beta-1 selective antihypertensives include:

  • Tenormin (atenolol)
  • Toprol, Lopressor (metoprolol)
  • Sectral (acebutolol)

While these medications are considered safer than non-selective beta-blockers for people with mild asthma, there is still some concern about the potential effects in people who have severe asthma.

Beta-agonist medications like albuterol are used to treat asthma. These medications widen the airways by activating the beta-2 receptors in the lungs.

ACE Inhibitors

ACE inhibitors widen the blood vessels by reducing the activity of the angiotensin-converting enzyme (ACE), a key enzyme in the renin-angiotensin-aldosterone system (RAAS).

These medications can cause you to experience a cough, wheezing, and breathing difficulties, especially if you have asthma. In fact, if you develop a persistent cough when taking an ACE inhibitor, experts recommend that you have a diagnostic evaluation for asthma.

Examples of ACE inhibitors include:

  • Vasotec (enalapril)
  • Capoten (captopril)
  • Lotensin (benazepril)

ARBs

Angiotensin receptor blockers (ARBs) lower blood pressure by reducing the activity of angiotensin, which is part of the RAAS. These medications are not considered harmful if you have asthma.

They are often used along with ACE inhibitors, and some people are switched from an ACE inhibitor to an ARB due to the ACE inhibitor-associated cough.

Common ARBs include:

  • Cozaar (losartan)
  • Diovan (valsartan)
  • Avapro (irbesartan)

Calcium Channel Blockers

Calcium channel blockers are used to lower blood pressure. They relax and widen the blood vessels by inhibiting the action of calcium, which plays a major role in activating muscles. Calcium is a necessary mineral in muscle contraction (activation), and when it contracts the muscles of the blood vessels, they become narrow.

Calcium channel blockers are not considered harmful for people who have asthma.

Examples of calcium channel blockers used to treat hypertension include:

  • Verelan, Calan (verapamil)
  • Norvasc (amlodipine)
  • Procardia, Adalat (nifedipine)

Diuretics

Diuretics are often referred to as "water pills' because they work by eliminating excess water from the body.

There are several types of diuretics, and thiazide diuretics are the type most commonly used in the treatment of hypertension. They specifically prevent reabsorption of sodium by the kidneys, which then leads to the elimination of excess water in the urine as the body balances the concentration of water and sodium.

As the body rids itself of excess water, pressure on the blood vessels is reduced, and blood pressure is lowered.

Some of the thiazide diuretics used for treating hypertension include:

  • Microzide (hydrochlorothiazide)
  • Lozol (indapamide)
  • Zaroxolyn (metolazone)

Diuretic medications are generally considered safe for asthma symptoms.

But thiazide diuretics may cause hypokalemia (low potassium) as a side effect. Low potassium causes a number of harmful health effects, including muscle weakness, abnormalities in heart rhythm, and blood sugar imbalance.

And, some bronchodilator asthma medications can also cause low potassium as a side effect. If you take a prescription thiazide diuretic for your blood pressure control, your doctor will monitor your potassium level whether you take asthma medication or not.

When you are taking any new medication, it's important that you follow instructions to avoid health problems, and it's also vital that you familiarize yourself with the side effects so you can get in touch with your doctor right away if you experience adverse effects.

A Word From Verywell

It is really important that you get the right treatment to keep your blood pressure at optimal levels. Hypertension treatment can be tricky if you have asthma, but there are drug options. And remember that lifestyle changes like getting more exercise, eating healthfully, and others can go a long way in helping to manage your hypertension as well.

Tell all your doctors and your pharmacist about each of your medical conditions—even if they seem irrelevant to your conversations—to help educate treatment recommendations.

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