The Effects of Hypertension Medications on Asthma

Woman taking antihypertensive medication
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Asthma is associated with an increased risk of hypertension (high blood pressure), but some of the medications used to manage hypertension can exacerbate asthma. Untreated hypertension leads to heart attacks, strokes, and kidney failure. Furthermore, hypertension increases the risk of severe asthma complications, so it's important that your hypertension is treated if you have asthma.

Certain antihypertensives (medications used to treat high blood pressure) can worsen asthma by causing the airways in the lungs to narrow. But there are antihypertensive options that don't negatively affect asthma or interfere with asthma treatments, so you can have good control of your hypertension and your asthma.

Antihypertensives

Antihypertensives fall into several categories, including beta-blockers, selective beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, and calcium channel blockers.

Your antihypertensive medications are selected 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, 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 asthma, may exacerbate the side effects of some asthma medications.

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.

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 you also have beta receptors in your lungs. And blocking beta receptors on respiratory passages can irritate the airways if you have asthma, causing them to constrict, which leads to shortness of breath and wheezing.

For this reason, if you are prescribed a 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 work by acting on the kidneys as urine is being formed. 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)

Thiazide diuretics may cause hypokalemia (low potassium) as a side effect. And beta-2 agonists used for treating asthma can also increase the risk of hypokalemia. Low potassium causes a number of harmful health effects, including muscle weakness, abnormalities in heart rhythm, and blood sugar imbalance. If you take a prescription thiazide diuretic for your blood pressure control, your doctor will monitor your potassium level.

A Word From Verywell

It is really important that you get the right treatment to keep your blood pressure at optimal levels. Your hypertension treatment can be complicated if you have asthma, but there are options.

That's why you need to tell all your doctors and your pharmacist about each of your medical conditions—even if they aren't in charge of treating it. For example, if you have a great asthma doctor, you still need to tell your pharmacist and the doctor who takes care of your blood pressure that you have asthma.

Besides prescription medications, there are a variety of treatment strategies for managing hypertension, including cardiovascular exercise, a healthy diet, and weight loss (if you are overweight).

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