Hypertension is a very common cardiovascular disease. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) are widely used to treat hypertension. Many patients with hypertension are vulnerable to the antihypertensive adverse effects, which potentially reduces the adherence rate. Therefore, we conducted this study in order to evaluate the safety profile of both classes (ACEi and ARBs) on respiratory functions.
Two main groups of subjects were studied: first group is healthy control subjects and the second group is hypertensive patients, which was subdivided into subgroups in order to investigate the effect of all tested medications (captopril, enalapril, lisinopril, losartan, and valsartan). Respiratory efficiency was evaluated by measuring pulmonary function tests: FEV1, FVC, and FEV1%. Measurements were done using micromedical spirometer.
We found that ARBs do not impair normal respiratory functions as measured by FEV1, FEV1%, and FVC in hypertensive patients. While ACEi treatments significantly reduced FEV1, FEV1%, and FVC compared to the other groups.
ARBs are not associated with any harmful effects on respiratory functions in hypertensive patients, unlike ACEi. As such, they could represent a first-choice treatment for hypertensive patients who are at high risk to the respiratory adverse effects.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: Scientific and ethical committees in the College of pharmacy, Basrah University approved this study.
1. Birhan, MM, Abebe, Y. Pulmonary function tests in hypertensive patients attending Zewditu Memorial Hospital, Addis Ababa, Ethiopia. Int J Hypertens 2018;2018:5492680. Search in Google Scholar
2. Schnabel, E, Karrasch, S, Schulz, H, Glaser, S, Meisinger, C, Heier, M, et al.. High blood pressure, antihypertensive medication and lung function in a general adult population. Respir Res 2011;12:50. Search in Google Scholar
3. Schnabel, E, Nowak, D, Brasche, S, Wichmann, HE, Heinrich, J. Association between lung function, hypertension and blood pressure medication. Respir Med 2011;105:727–33. Search in Google Scholar
4. Tom, B, Dendorfer, A, de Vries, R, Saxena, PR, Jan Danser, AH. Bradykinin potentiation by ACE inhibitors: a matter of metabolism. Br J Pharmacol 2002;137:276–84. Search in Google Scholar
5. Packard, KA, Wurdeman, RL, Arouni, AJ. ACE inhibitor-induced bronchial reactivity in patients with respiratory dysfunction. Ann Pharmacother 2002;36:1058–67. Search in Google Scholar
6. Abdi, R, Dong, VM, Lee, CJ, Ntoso, KA. Angiotensin II receptor blocker-associated angioedema: on the heels of ACE inhibitor angioedema. Pharmacotherapy 2002;22:1173–5. Search in Google Scholar
7. Ong, HT, Ong, LM, Ho, JJ. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in patients at high risk of cardiovascular events: a meta-analysis of 10 randomised placebo-controlled trials. ISRN Cardiol 2013;2013:478597. Search in Google Scholar
8. Elliott, WJ, Calhoun, DA, DeLucca, PT, Gazdick, LP, Kerns, DE, Zeldin, RK. Losartan versus valsartan in the treatment of patients with mild to moderate essential hypertension: data from a multicenter, randomized, double-blind, 12-week trial. Clin Therapeut 2001;23:1166–79. Search in Google Scholar
9. Hedner, T, Oparil, S, Rasmussen, K, Rapelli, A, Gatlin, M, Kobi, P, et al.. A comparison of the angiotensin II antagonists valsartan and losartan in the treatment of essential hypertension. Am J Hypertens 1999;12:414–7. Search in Google Scholar
10. Schnabel, E, Karrasch, S, Schulz, H, Gläser, S, Meisinger, C, Heier, M, et al.. High blood pressure, antihypertensive medication and lung function in a general adult population. Respir Res 2011;12:50. Search in Google Scholar
11. Kanazawa, H, Hirata, K, Yoshikawa, J. Imbalance between vascular endothelial growth factor and endostatin in emphysema. Eur Respir J 2003;22:609–12. Search in Google Scholar
12. Kanazawa, H, Hirata, K, Yoshikawa, J. Effects of captopril administration on pulmonary haemodynamics and tissue oxygenation during exercise in ACE gene subtypes in patients with COPD: a preliminary study. Thorax 2003;58:629–31. Search in Google Scholar
13. Williams, B. Drug discovery in renin-angiotensin system intervention: past and future. Ther Adv Cardiovasc Dis 2016;10:118–25. Search in Google Scholar
14. Kanazawa, H, Hirata, K, Yoshikawa, J. Influence of oxygen administration on pulmonary haemodynamics and tissue oxygenation during exercise in COPD patients with different ACE genotypes. Clin Physiol Funct Imag 2003;23:332–6. Search in Google Scholar
15. Pinargote, P, Guillen, D, Guarderas, JC. ACE inhibitors: upper respiratory symptoms. BMJ Case Rep 2014;2014. Search in Google Scholar
16. Bhatt, SP, Soler, X, Wang, X, Murray, S, Anzueto, AR, Beaty, TH, et al.. Association between functional small airway disease and FEV1 decline in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2016;194:178–84. Search in Google Scholar
17. Bhatt, SP, Terry, NL, Nath, H, Zach, JA, Tschirren, J, Bolding, MS, et al.. Association between expiratory central airway collapse and respiratory outcomes among smokers. J Am Med Assoc 2016;315:498–505. Search in Google Scholar
The online version of this article offers supplementary material (https://doi.org/10.1515/jbcpp-2020-0243).
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