The Correlation of Lung Function Parameters, Blood Pressure and Beta-Blocker Medication in a General Population

Abstract

Objectives Prior studies have investigated possible links between blood pressure, antihypertensive medication, especially beta-blockers and impairment of lung function. The aim of our study was to investigate an association between blood pressure, antihypertensive medication, focusing on beta-blockers, and its influence on lung function parameters in our adult population.

Methods From the two analysed cohorts of the population-based Study of Health in Pomerania (SHIP-1 and SHIP-TREND), pooled data for interview-based information, lung function variables including bodyplethysmography and blood pressure variables were used to perform adjusted linear regression analyses. Association analyses were conducted for the pooled population.

Results Within the whole pooled population we found some minor statistically significant interrelations in the multivariate analyses for blood pressure and lung function parameters. Statistical correlation between lung function and blood pressure were significant but too weak to be deemed clinically relevant.

We also found interrelations between lung function and use of beta-blocker medication. Within the subgroup of individuals with antihypertensive medication containing beta-blockers compared to the reference group we found lower dynamic and static volumes e. g. for FEV1 (–70 ml), FVC (–90 ml), a reduction of TLC (–130 ml) and ITGV (–100 ml), however we did not find an increase in airway resistance (Rtot).

Conclusion Based on the data of SHIP-1 and SHIP TREND our results confirm a minor association between blood pressure and lung function. More importantly, we have seen a significant decrease of lung volumes for hypertensive patients with beta- blocker medication as described in literature before. To the best of our knowledge, we are the first to examine the interrelation between blood pressure, medication and lung function in an epidemiological study using data of spirometry, body plethysmography and CO transfer.

Zusammenfassung

Ziel In der vorliegenden Studie haben wir die Korrelation von Blutdruck- und Lungenfunktionswerten sowie antihypertensiver Medikation in Bezug auf Lungenfunktionsparameter in der Spirometrie und Bodyplethysmografie untersucht.

Ein besonderer Fokus lag auf der Subgruppe der Studienteilnehmer mit Betablockern in der Medikation. Das Ziel war es zu klären, inwieweit Blutdruck mit Lungenfunktionsparametern assoziiert ist und inwieweit blutdrucksenkende Medikamente, insbesondere Betablocker, die Lungenfunktionsparameter innerhalb der epidemiologischen Studienpopulation beeinflussen.

Methode Die untersuchten Daten stammen aus den zwei Kohorten der bevölkerungsbasierten Study in Health in Pomerania (SHIP-1 und SHIP-TREND). Aus der Studie liegen interviewbasierte Informationen, Lungenfunktionsvariablen, einschließlich Bodyplethysmografie und Blutdruckvariablen vor. Die Daten wurden verwendet, um angepasste lineare Regressionsanalysen durchzuführen. Assoziationsanalysen wurden für die gepoolte Population durchgeführt.

Ergebnisse Innerhalb der untersuchten Population fanden wir Wechselbeziehungen in der multivariaten Analyse für Blutdruck- und Lungenfunktionsparameter. Die gefundenen Zusammenhänge waren gering ausgeprägt, formal jedoch signifikant. Die Korrelation zwischen Bluthochdruck und antihypertensiver Medikation und Lungenfunktionsparametern war ausschließlich mit der Gabe von Betablockern assoziiert. Im Vergleich zur Referenzgruppe fanden wir in der Gruppe der mit Betablockern behandelten Teilnehmenden niedrigere Lungenvolumina für FEV₁ (–70 ml), FVC (–90 ml), TLC (–130 ml) und ITGV (–100 ml), während wir keinen Anstieg des Atemwegswiderstandes (Rtot) beobachten konnten.

Schlussfolgerung Basierend auf den Daten der bevölkerungsbezogenen Study of Health in Pomerania (SHIP-1 und SHIP TREND) fanden wir einige, kleinere Zusammenhänge zwischen Blutdruck und Lungenfunktionsparametern.

Zusätzlich haben wir eine signifikante Abnahme spirometrisch und bodyplethysmografisch bestimmter Lungenvolumina bei hypertensiven Patienten mit Betablockern gesehen, wie von anderen Autoren bereits beschrieben. Diese Veränderungen in der Spirometrie waren nicht von einem Anstieg des Atemwegswiderstandes begleitet. Unseres Wissens nach ist dies die erste Untersuchung aus einer großen epidemiologischen Studie von Blutdruck, Medikation und Lungenfunktion, in welcher neben spirometrischen Daten auch Daten der Bodyplethysmografie und des CO-Transfers untersucht wurden.

Publikationsverlauf

Eingereicht: 16. Mai 2021

Angenommen: 06. Juli 2021

Artikel online veröffentlicht:
02. August 2021

• References

• 1 Kearney PM, Whelton M, Reynolds K. et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22: 11-19
• 2 Mannino DM, Higuchi K, Yu TC. et al. Economic Burden of COPD in the Presence of Comorbidities. Chest 2015; 148: 138-150 DOI: 10.1378/chest.14-2434.
• 3 Sinden NJ, Stockley RA. Systemic inflammation and comorbidity in COPD: a result of ‘overspill’ of inflammatory mediators from the lungs? Review of the evidence. Thorax 2010; 65: 930-936 DOI: 10.1136/thx.2009.130260.
• 4 Yanbaeva DG, Dentener MA, Creutzberg EC. et al. Systemic effects of smoking. Chest 2007; 131: 1557-1566 DOI: 10.1378/chest.06-2179.
• 5 Selby JV, Friedman GD, Quesenberry CP. Precursors of essential hypertension: pulmonary function, heart rate, uric acid, serum cholesterol, and other serum chemistries. Am J Epidemiol 1990; 131: 1017-1027
• 6 Sparrow D, Weiss ST, Vokonas PS. et al. Forced vital capacity and the risk of hypertension. The Normative Aging Study. Am J Epidemiol 1988; 127: 734-741
• 7 Kannel WB, Hubert H, Lew EA. Vital capacity as a predictor of cardiovascular disease: the Framingham study. Am Heart J 1983; 105: 311-315
• 8 Enright PL, Kronmal RA, Smith VE. et al. Reduced vital capacity in elderly persons with hypertension, coronary heart disease, or left ventricular hypertrophy. The Cardiovascular Health Study. Chest 1995; 107: 28-35
• 9 Engström G, Hedblad B, Valind S. et al. Increased incidence of myocardial infarction and stroke in hypertensive men with reduced lung function. J Hypertens 2001; 19: 295-301
• 10 Doshan HD, Rosenthal RR, Brown R. et al. Celiprolol, atenolol and propranolol: a comparison of pulmonary effects in asthmatic patients. J Cardiovasc Pharmacol 1986; 8 (Suppl. 04) S105-S108
• 11 Margretardottir OB, Thorleifsson SJ, Gudmundsson G. et al. Hypertension, systemic inflammation and body weight in relation to lung function impairment – an epidemiological study. COPD 2009; 6: 250-255
• 12 Schnabel E, Nowak D, Brasche S. et al. Association between lung function, hypertension and blood pressure medication. Respiratory Medicine 2011; 105: 727-733 DOI: 10.1016/j.rmed.2010.12.023.
• 13 Zvizdic F, Begic E, Mujakovic A. et al. Beta-blocker Use in Moderate and Severe Chronic Obstructive Pulmonary Disease. Med Arch 2019; 73: 72-75 DOI: 10.5455/medarh.2019.73.72-75.
• 14 Volzke H, Alte D, Schmidt CO. et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol 2011; 40: 294-307 DOI: 10.1093/ije/dyp394.
• 15 Ewert R, Ittermann T, Bollmann T. et al. [Lung Health Data of the Study of Health in Pomerania – a Review of Samples, Methods and First Results]. Pneumologie 2017; 71: 17-35 DOI: 10.1055/s-0042-117461.
• 16 Chaturvedi S. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): is it really practical?. Natl Med J India 2004; 17: 227
• 17 Nelson SB, Gardner RM, Crapo RO. et al. Performance evaluation of contemporary spirometers. Chest 1990; 97: 288-297 DOI: 10.1378/chest.97.2.288.
• 18 Standardization of spirometry – 1987 update. Official statement of American Thoracic Society. Respir Care 1987; 32: 1039-1060
• 19 Quanjer PH, Tammeling GJ, Cotes JE. et al. Lung volumes and forced ventilatory flows. Eur Respir J 1993; 6 (Suppl 16): 5-40 DOI: 10.1183/09041950.005s1693.
• 20 Bollmann T, Ittermann T, Glaser S. et al. Reference Values for Pulmonary Single-Breath Diffusing Capacity – Results of the “Study of Health in Pomerania”. Pneumologie 2021; 75: 268-275 DOI: 10.1055/a-1234-7151.
• 21 Glaser S, Koch B, Ittermann T. et al. Influence of age, sex, body size, smoking, and beta blockade on key gas exchange exercise parameters in an adult population. Eur J Cardiovasc Prev Rehabil 2010; 17: 469-476 DOI: 10.1097/HJR.0b013e328336a124.
• 22 Schnabel E, Karrasch S, Schulz H. et al. High blood pressure, antihypertensive medication and lung function in a general adult population. Respir Res 2011; 12: 50 DOI: 10.1186/1465-9921-12-50.
• 23 Loth DW, Brusselle GG, Lahousse L. et al. beta-Adrenoceptor blockers and pulmonary function in the general population: the Rotterdam Study. Br J Clin Pharmacol 2014; 77: 190-200 DOI: 10.1111/bcp.12181.
• 24 Magnussen C, Ojeda FM, Rzayeva N. et al. FEV1 and FVC predict all-cause mortality independent of cardiac function – Results from the population-based Gutenberg Health Study. Int J Cardiol 2017; 234: 64-68 DOI: 10.1016/j.ijcard.2017.02.012.
• 25 Lutter JI, Jorres RA, Kahnert K. et al. Health-related quality of life associates with change in FEV1 in COPD: results from the COSYCONET cohort. BMC Pulm Med 2020; 20: 148 DOI: 10.1186/s12890-020-1147-5.
• 26 Vaz Fragoso CA, Van Ness PH, McAvay GJ. FEV1 as a Standalone Spirometric Predictor and the Attributable Fraction for Death in Older Persons. Respir Care 2020; 65: 217-226 DOI: 10.4187/respcare.07012.
• 27 Malerba M, Montuschi P, Radaeli A. et al. Role of beta-blockers in patients with COPD: current perspective. Drug Discov Today 2015; 20: 129-135 DOI: 10.1016/j.drudis.2014.09.005.
• 28 Minor DS, Meyer AM, Long RC. et al. beta-Blockers and chronic obstructive pulmonary disease: inappropriate avoidance?. J Clin Hypertens (Greenwich) 2013; 15: 925-930 DOI: 10.1111/jch.12204.
• 29 Lipworth B, Skinner D, Devereux G. et al. Underuse of beta-blockers in heart failure and chronic obstructive pulmonary disease. Heart 2016; 102: 1909-1914 DOI: 10.1136/heartjnl-2016-309458.
• 30 Lipworth B, Wedzicha J, Devereux G. et al. Beta-blockers in COPD: time for reappraisal. Eur Respir J 2016; 48: 880-888 DOI: 10.1183/13993003.01847-2015.
• 31 Dransfield MT, Voelker H, Bhatt SP. et al. Metoprolol for the Prevention of Acute Exacerbations of COPD. N Engl J Med 2019; 381: 2304-2314 DOI: 10.1056/NEJMoa1908142.
• 32 Canepa M, Franssen FME, Olschewski H. et al. Diagnostic and Therapeutic Gaps in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease. JACC Heart Fail 2019; 7: 823-833 DOI: 10.1016/j.jchf.2019.05.009.