A Journal Article-Based Approach to Understanding the Clinical Aspects of Hypertension
Volume 4 Issue 6 iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii June 2019
Context and Study Objective
Conventional wisdom holds chronic obstructive pulmonary disease (COPD) to be a contraindication to β - blocker therapy as it can precipitate bronchospasm. However, the exclusion of an entire class of agents renders achieving BP control difficult, particularly when 120/80 mg may be the goal. This publication by Bhatt explored whether individuals receiving β - antagonist therapy were in fact more like to suffer a COPD exacerbation.
Design, Setting, Participants
Participant data from the observational COPDGene study were analyzed retrospectively. Persons aged 45-80 were eligible if they suffered from COPD, currently/previously smoked, and were either African American or Hispanic. Those experiencing a COPD flare or cardiac event less than 1 month prior to recruitment were excluded. Persons with lung disease other than COPD or asthma were ineligible. COPD was diagnosed via pulmonary function testing (PFT).
Results
-Study characteristics: 3500 subjects. Mean age 63. 45% women. 20% Black. 80% Hispanic. 40% current smokers. 25% asthmatic. 30% on supplemental oxygen. 50% hypertensive.
-Most participants had moderate-to-severe COPD; 15% suffered from very severe disease.
-Individuals with more severe COPD, higher flare rates, or a greater number of respiratory medications were less likely to be on β- antagonists.
-After 2 years, surveillance, β- blocker usage was associated with 25% fewer exacerbations, a finding that persisted after adjustment for confounders such as cardiovascular disease, COPD severity, and the number of respiratory agents.
Clinical Perspective
-Importantly, β- 1 selective (metoprolol, nebivolol) rather than non-specific β- 1/2 agents (propranolol) should be prescribed. Carvedilol, a mixed α/ β - antagonist, lacks sufficient data to comment on its safety.
-It is curious that one can simultaneously prescribe a β -antagonist and β -agonist (eg albuterol) with each not negating the other's efficacy.
-Criticism: This observational study does not prove causality. However, patients with COPD are excluded from randomized trials of β -blockers. Moreover, this publication is consistent with the literature.
-Disclosures: I have no conflicts to declare. The study was researcher-funded but the authors received honoraria from Merck or GlaxoSmithKline.
Creator & Author: Hillel Sternlicht, MD      
© 2019 Concepts in Hypertension LLC