Hill N S
Arch Intern Med. 1986 Jan;146(1):129-33.
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. beta-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, beta-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassium-wasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or beta-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents.
当慢性阻塞性肺疾病（COPD）患者需要针对全身性高血压进行药物治疗时，一些特殊的考虑因素可能会影响抗高血压药物的选择及后续治疗管理。噻嗪类利尿剂对气道功能无不良影响，是初始治疗的首选药物。β受体阻滞剂在抗高血压治疗中通常被视为一线药物，但即使是相对具有心脏选择性的β受体阻滞剂，也可能增加阻塞性肺病患者的气道阻力，因此在这类患者中应谨慎使用（若使用的话）。尽管排钾利尿剂是治疗COPD患者高血压的首选药物，但它们可能会使通气不足患者的二氧化碳潴留情况恶化，并使接受皮质类固醇治疗的患者低钾血症加重。此外，β受体激动剂可能会使已因利尿剂导致低钾血症的患者血清钾水平大幅降低。接受排钾利尿剂治疗的COPD患者，若患有慢性呼吸性酸中毒、正在接受皮质类固醇或β受体激动剂治疗，应密切监测电解质水平，并考虑补充钾剂治疗，或最好使用保钾药物治疗。
