Treatment of Hypertension in Patients with Asthma

Author(s): Christiansen SC and Zuraw BL

N Engl J Med 2019; 381: 1046-57

Airway diseases
Epidemiology
General respiratory patient care

Digest Author(s): Stylianos Loukides, e-Learning Director / 20 September, 2019

Asthma and hypertension are common chronic diseases, each with attendant morbidity, mortality, and economic effects.Patients with asthma are more likely to have Hypertension irrespective of traditional risk factors. The role of Hypertension in patients with asthma is largely unexplored. Considering the mechanistic relationship between asthma and Hypertension many factors are involved. These factors are mainly attributed either to environmental changes or/and to changes relating to both diet and life style. There is an interaction between innate and adaptive immune response, alterations in microbiome and enhanced T1 and T17 inflammatory processes. These alterations lead to remodeling of smooth muscle cells and affect in different directions either the blood vessels or/and the airway. The above mechanistic view may also have implications in the disease management and particularly in treatment strategies. The first approach is to control both diseases with the respective treatment strategies, to modify lifestyle factors and to treat co-existing diseases like sleep apnoea. Interestingly some of the pharmacologic agents used for both diseases may have some specific considerations due to possible side effects.

Comment

This challenging review raised some important points in the direction of both diseases. Mechanistic data supports a low T2 process in the co-existence of asthma and Hypertension. This is quite important in terms of asthma management. In order to better characterize the above mechanistic process we need to consider some additive features in terms of age of onset, presence of atopy, co-morbidities use of OCS and underlying severity. The treatment for asthma and Hypertension should be based on a multifactorial process where modifications and changes in lifestyle are needed. For the pharmacologic management in this specific population we need to minimize the dosages and to adjust the treatment strategies in order to avoid side effects.