Asthma med and high blood pressure - Asthma UK communi...

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Asthma med and high blood pressure

Hi all,

Has anyone had any raised blood pressure problems from asthma meds, I have read that LABAs (salmeterol, seretide, advair, symbicort, oxis, formeterol) can raise blood pressure. It would be good to know if anyone has a problem with this.

Cheers

RI

18 Replies
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Hi, I have asthma and high blood pressure but I don't think my high blood pressure comes from my asthma meds as I have a family history of inherited problems, and also took an anti-depressant for a while that raised my blood pressure.

Jen

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hi i have had bp since being diagnosed with chest infction induced athma at christmas/new year. am on brown and blue inhalers nad now turquoise one, bp still high but dr says wants to sort breathing out then sort bp out, so just have to keep monitoring it at home every day and try keep chilled out! not easy""

jackie

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Hi thanks for replying, My blood pressure has gone up recently, since having had very low blood pressure all my life, and is now on the edge of being high. I would like to take HRT, but I know the combination of asthma and HRT is not great. and I think elevated blood pressures will rule this out. I am thinking that maybe my asthma drugs (seretide particularly) have caused the raise in pressure, as I am on very high doses. I am looking to engage my gp in meaningful discussion about this subject, and want all the information I can get.

Thanks

RI

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Hi RI

Like you, my blood pressure used to be considered low – 90/50 – but was normal for me as there is a family history of low blood pressure on my father’s side. However since taking symbicort 400/12 during last two years my blood pressure has increased to 120/80- normal according to docs. Haven’t changed diet nor any other changes in lifestyle so just put it down to meds.

I believe the long acting ingredient in this inhaler and similar to seretide – formoterol - is responsible for my increase in blood pressure. Not to mention loadsa pred. One of the ‘cautions’ re side effects in any sort of LABA is that of an increase in blood pressure.

I’m getting to ‘that age’ -like you? - although can’t take HRT because of previous DVT’s caused by both ‘ordinary’ and progesterone only pill.

I suppose the fact that we both started off with hypo as opposed to hyper tension is positive. Have to say I don’t miss light headed ‘not here’ and fainting symptoms with low blood pressure.

I would love to be able to take HRT because I believe this drug WOULD improve current chronic asthma instability symptoms, which I personally believe is happening because I’m perimenopausal.

I’ve included a link which might help you re discussions with your doc.

timesonline.co.uk/tol/news/...

It’s tough being a woman!

Take care.

Mia

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Thanks Mia,

I am in the same situation as you. perimenopausal, and all that goes with it.

My asthma has been getting worse for the last 10 years, with a few breaks.

one of the reasons that I think my blood pressure has gone up is I have done less exercise inthe last few months because I've had so many asthma problems you get out of the habit.

I am getting awful hot flashes, and waking up at night soaking wet etc, boob probs etc.

my sisters took HRT very successfully. Although one of my sisters has developed asthma post menopause, and she still takes HRT. I am so fed up with everything at the moment, that I think it would be better to 'firefight' the asthma rather than take all this medicine all the time. However the consultant thought that I should take up residence outside the hospital if I decide to do that!

i HATE THE fact you go the gp, and they only let you talk about 1 thing, when you see the consultants they look at their watch and pager, because youre not as ill as the people in icu, when you want to be able to talk about the whole picture.

as I mostly see the consultant for asthma, when I go to gps I never see the same person, ( I see them scrolling down the computer screen to gen up on the notes, which for me are huge cos of the asthma) I feel as though as I am having to make all the decisions, because I am the only person that knows the whole picture, but I am not a doctor, and although I am well read, and have opinions, and a lot of docs in family its tough.

thanks everyone

ri

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Know this is an oldish thread, but it is ringing so many bells for me

I've just been for a 'new patient check' at my new practice and blood pressure was on the high side, having been pretty much spot on 120/80 in the 'good old days'. So it's useful to know it might be due to the LABA. I've been on 6 puffs a day of symbicort 400/12 for last nine months, so will definitely discuss reducing this at asthma review next week. I've a family history of heart disease so I want to be careful (while balancing that with trying to keep asthma under control of course!).

I'm also at that time of life when I am probably perimenopausal, though trying not to think about it, so wondering if that is a link to asthma getting worse - the article you linked to makes interesting reading Mia.

And Ri I know just what you mean about always seeing someone different so you are expected to be the expert. I've just changed to a very small practice for just this reason - too early to tell yet if it will work out but it is looking better already!

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Hi everyone,

Long-acting beta-agonists (LABAs) are not particularly known to cause high blood pressure, although they can make pre-exisiting high blood pressure worse, and there is a caution on their use in people with high blood pressure for this reason. Steroids, especially oral steroids, certainly can increase blood pressure. It's possible that very high doses of some inhaled steroids can also have this effect. Other drugs that commonly cause high blood pressure are: oestrogens and other hormones (eg the pill and HRT), migraine medications containing sumatriptan, decongestants containing pseudoephedrine, ciclosporin, old-fashioned MAOI antidepressants, and of course alcohol and illicit drugs like cocaine, ecstacy and amphetamines.

It's also worth bearing in mind that high blood pressure is a very common problem, even in people without any apparent triggers and without any family history, so it is possible that it is entirely unrelated to anything that you are taking.

I have high blood pressure secondary to oral steroids and the contraceptive pill (part of my asthma treatment, as I have hormone sensitive asthma, and therefore difficult to stop). At the moment I am not on any blood pressure lowering medication, but I will probably have to start taking it at some point. There are many different medications available for high blood pressure, so it is very likely that most people will be able to find one that suits them. I know it can be extremely frustrating to think of taking medication to counteract things that are possibly a side effect of other medication, but it is better than having uncontrolled asthma!

Hope this helps

Em H

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For years I have been trying to find the opposite- do blood pressure tablets cause Asthma symptoms- the nefidepine prescribed by my GP years ago states on the leaflet that it can cause breathing problems - now I am on Fostair and Salamol ..?!?!

Unfortunately I have never been able to get a response on this site from anyone in similar circumstances..?!

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Me too!

Hi Guys

Can I join you? I'm menopausal and my blood prssure has been up and down for a couple of years. It's up again and I have to see GP in a couple of weeks to discuss meds. I take hrt (Oestrogel) and also another drug (Celbrex) that can raise blood pressure, but my blood pressure has been up and down since before these were prescribed. I'm wondering if my recent flare up of arthritis and Sjogren's could have influenced the BP. Any ideas?

Kathyx

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Hi all,

I’ve just reread the patient information leaflet for symbicort 400/12 and it lists as a side effect that ‘changes in blood pressure may occur’ as a very rare, <1/10,000 - less than one in ten thousand people –adverse reaction. Not sure if this symptom is listed for lower doses of symbicort used for SMART e.g. 200/6.

Also have skimmed the patient information leaflet past the, I-already- know - worst Frankenstein side effects - through closed gritty eyes (am recovering from keratitis) – for predsisolone which reads:- ‘salt and fluid retention may lead to an increase in blood pressure. Avoid excess salt in your diet - follow dietary guidelines’

Finally have reread old patient information leaflet – I’m the world’s worst hoarder_- for foradil - generic drug formoterol – which I used to take when first experiencing big lack of control some years ago prior to using symbicort which includes LABA formoterol as well as budesonide – steroid preventer med.

The leaflet – foradil one - states ‘use with caution in high blood pressure’

All very confusing for practical use, and other worrying none related asthma symptoms (?) such as high blood pressure, but most of all for regular long term use, i.e. over two years.

However I can’t find any other research which either reassures or negates use of symbicort re high blood pressure. Taking both drugs – formoterol and budesonide together in one inhaler appears to be safe -well it must be re the popularity of the SMART programme - but nobody seems to be able to explain why or how.

All single LABA’s to include generic formoterol and salmeterol have many more warnings attached to them concerning some potentially heart related problems such as high blood pressure and diabetes as well as heart disease itself.

As a positive it might be more useful to use the two drugs – LABA’s and steroids independently for a more selective and individualised approach to asthma control and perhaps other side effects. I know this sounds like a contradiction to what I’ve just described but this approach may be most useful for those of us ‘at a certain age’ - meaning the sort of age we are at in physical terms and related hormonal symptoms as well as a… well hopefully… more sensible one in terms of ‘there is no going back and we aren’t getting any younger mindset’ and most importantly if already suffering from other symptoms related to potential heart problems.

I’m going to discuss all of this with chest prof next month.

Hi Kathy,

I suffer from a skin autoimmune condition. It has a life of its own, but fortunately doesn’t cause me any physical smptoms like asthma does. Don’t think there is any sort of relationship between my skin autoimmune problem and similar autoimmune conditions such as arthritis concerning increased blood pressure, although I ‘m certain there is a genetic link via internal and external ‘skin’ where inflammatory processes are concerned.

Think those of us experiencing the big pre M – me, Kathy, RI, and Ali on this thread -need to discuss our concerns with relevant docs very soon.

Mia

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Thanks, Mia

...for all that information. Food for thought!

Just something to make you smile - my grandaughter (due to be born in August) has a preliminary name of Mia Grace. It sounds very feminine for the first little girl (if indeed, the baby is a girl!) to be born in hubbies family for 4 generations.

Kathyx

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That's pretty much what I said, Mia - there is a caution on the use of LABAs in pre-existing high blood pressure, but no actual evidence that they cause high blood pressure per se. As I said, prednisolone certainly does (as I know from personal experience, unfortunately) and it may be that some systemic absorption of high dose inhaled steroids could have this effect.

It's always worth approaching very rare side effects listed in patient information leaflets with some caution - drug companies often feel obliged (legally or otherwise - depending on which country the drug is produced in) to list every event that has occured in clinical trials when patients were on the drug - whether or not it is directly related. High blood pressure is a very common problem, and LABA use is common too - the two are bound to coincide in thousands of people.

I think it is a bit of an unknown issue, but personally I don't think there is any compelling evidence that LABAs cause hypertension. As with any drug, though, it's a case of individuals weighing up risks and benefits.

Interesting comments on this thread - I have passed on some of the comments on the 'M' phenomenon to my mum ('Dragonlady' occasionally on here) although I fear she is too far into denial to read about it herself!

Em H

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hi all,

On the leaflets for my american advair same as seretide, High blood pressure is listed as a side effect. There is also a warning for those with high blood pressure to consult their doctor before use. I think that as these drugs are still relatively new their longterm effects on blood pressure in the older population are probably untested. I am not talking about life threatning blood pressure, (but just raised levels) I have now been using labas for 9 years. I think that it is only through this type of dialogue that we start to promote possible research.

Obviously there are choices here. I start to get very ill if I don't take the Labas, and I have no obvious side effects to elevated blood pressure... so really when I feel ok- its a no-brainer of course I take the asthma drugs, but its good to know what other people are experiencing.

Any other comments welcome.

Ri

PS, I am not overweight, and I see a nutritionist, and used to be very fit until asthma intervened

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One of the main goals of treatment in chronic asthma, especially in older people should be to reduce the long term deterioration in pulmonary function and if possible without the use of medications that could increase the risk of heart disease and related conditions such as an unexplained increase in blood pressure.

It’s frustrating – given that symbicort work so well to control acute as well as chronic asthma symptoms - that this asthma med and other similar ones such as seretide with the ‘protective’ influence of a steroid inhaler component , and/or oral steroids appear to increase these risks as indicated by Ri re US warnings and EmH re oral steroids.

The relatively short time these sorts of drugs have been used and tested makes those of us old enough to experience worrying side effects such as an unexplained increase in blood pressure wondering if we’ve all been signed up as involuntary human guinea pigs.

A severe asthma exacerbation will stress the heart and in younger people without a long term history of severe asthma and heart related disease shouldn’t have a lasting effect.

However, I’m old enough to remember taking a combined drug – intal compound (sodium cromoglycate and isoprenanal) - for asthma relief when young It worked very well to improve immediate asthma symptoms such as wheeziness, but what I remember most was the increased heart rate due to the effect of isoproprenaline. Then, as now, for other SABA’s and LABA’s it was marketed as a more ‘selective’ treatment for asthma. I’m relieved I tried this drug when younger rather than now.

It’s easy and understandable for docs to gloss over the side effects of drugs like symbicort especially when trying to stabilise either acute or chronic asthma symptoms.

But high blood pressure damages blood vessels and worst of all is or can be symptomless or with mild symptoms attributable to many other diseases.

I don’t tick any of the lifestyle boxes for an increase in blood pressure, - am underweight if anything, healthy diet, can still run, no illicit drugs, low and self imposed alcohol intake cos of allergy probs, lifelong non-smoker, no family history… quite a boring lifestyle really… yet still have an unexplained increase in blood pressure and other heart related symptoms…

Has anyone else experienced similar?

Hi EmH,

Concerning the concept of denial…

…‘ Denial allows someone to keep going unchanged despite reality. Denial is the path of psychological and moral least resistance’

We have Sigmund, (1859-1939) and most of all his daughter Anna, (1895 -1982) Freud to thank for this concept.

It’s also been recognised that denial is an important factor in public health.

In plain English why people won’t accept a diagnosis and then take the meds they need to take, or make lifestyle adjustments. Sounds a bit close for comfort…

Mia

(not little Miss Perfect)

PS. Kathy,

Hope you get a grand daughter, although doesn’t really matter what sex as long as he/she arrives safely.

I love the name Mia Grace. Both names have Latin roots, and Mia is often used as a short form of another slightly longer name. Grace is self explanatory and sounds so elegant.

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I don’t think that most doctors could be accused of ‘glossing over’ the side effects of Symbicort or any other commonly used drug – most doctors are only too well aware of the risk of side effects, including side effects which may not previously have been noted in association with a particular drug. An important part of the prescribing of any drug is surveillance for, and reporting of, any new side effects. However, in the case of LABAs and hypertension, I just don’t believe there is compelling evidence of an association. The number of people in the developed world using LABAs is such that even a weak association with hypertension would be expected to be picked up very readily, and the very extensive safety data for these drugs simply don’t appear to support this.

As I have previously said, there is certainly an increased risk of hypertension with oral steroids, and there may be a slight effect with the very high dose inhaled steroids in high dose Symbicort. As for all drugs, there needs to be a thorough analysis of the risks and benefits of treatment for the individual patient before a drug is prescribed. However, given that uncontrolled asthma is undoubtedly dangerous, and that hypertension is relatively easily screened for, monitored and treated, the evidence would still appear to very much support using Symbicort or related drugs where necessary to gain control of asthma.

The example of isoprenaline in Intal Compound is a little misleading, as it is a very different drug to our modern day beta-agonists. As a beta-agonist, isoprenaline certainly is more selective than the even older alternatives such as adrenaline and ephedrine, which are combined alpha- and beta-agonists. However, isoprenaline is far less selective than salbutamol, salmeterol, formoterol etc, which are pure beta-2 agonists. It is the effect on beta-1 receptors, which is lacking in the more modern drugs, that causes isoprenaline to increase blood pressure.

As previously discussed, hypertension is a very common condition – it affects around 12 – 20% of the population of this country. Of these people, over 90% will have ‘essential hypertension’, meaning that no one underlying cause for it can be found. In these people, the raised blood pressure is likely to be due to a combination of factors, including genetics and the effects of the blood vessels becoming less elastic with increasing age.

It is very frustrating when no particular cause can be found for a particular symptom or condition, and we have a natural tendency to want to explain things and link isolated conditions. However, the reality is that in most cases of hypertension this will not be possible, and attributing cases of essential hypertension to a very commonly used class of drugs like the LABAs risks severely compromising asthma treatment.

Given the frequency of hypertension in the population, and the frequency of LABA use on this board, there will doubtless be a great many people reading this who are hypertensive and are using LABAs. With many of these, due to the natural history of the conditions (and the possible association with the menopause), there may appear to be a temporal relationship between use of LABAs and onset of hypertension. However, careful study of population data would be required to even begin to postulate an association.

I am hypertensive, and on high dose inhaled steroids and inhaled LABA (fluticasone and formoterol, in my case). I genuinely do not believe that these drugs have anything to do with my hypertension, which is likely to be attributable to oral steroids, the combined oral contraceptive pill, and family history. However, even if I did believe that the inhalers were responsible, it would still not be a difficult decision – uncontrolled asthma presents far more of a threat to me than hypertension.

My use of the word denial was in reference to my mum’s attitude to the menopause, rather than being germane to the current topic of discussion!

Em H

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The side effects of some drugs can sometimes only become apparent after some years of use and whether or not there may be long term cardiac side effects with the drugs under discussion it does help to discuss symptoms and share experiences either positive or not.

This is a patient forum and not a medical one so comments like ‘glossing over’ have been used by me - patient messenger -to describe other patients perspectives (discussed in clinic and in ward) about the way their concerns related to LABAS plus related increased blood pressure symptoms have been listened to or not. Have to say I’m interested too from my own similar experience.

We’re all stakeholders in our treatment for asthma and whether doctors suffering from asthma or not, it is important to listen to concerns from everyone.

I remember the first time I started using symbicort - 200/6 dose – approximately three years ago.

It was like the proverbial ‘I’m cured’ miracle drug re asthma control, especially during the day. Heck was even able to return to my six minute mile running pace over marathon distance. The feeling of euphoria at being able to return to a normal active lifestyle was enough to make me feel grateful... just to be and truly feel alive again. Sorry for emotive language but that’s how it felt re total asthma control and to forget I had asthma.

Later on had to switch to the 400/12 strength not long after a near fatal exacerbation as the docs say (including intubation). after trying various other meds - for similar although not quite as good control - plus the ubiquitous pred ‘as and when quite often needed’ as opposed to previous eight years only ‘as and when’ if that makes sense.

Again the higher dose symbicort worked and is still working extremely well today as I type re overall daytime control of asthma symptoms…plus now a few worrying side effects as previously described on this thread and another…

It’s useful to keep a window on the world concerning the way in which other countries view the use of these drugs used to treat asthma.

For example ‘black box’ warnings -that is the alert most urgent short of withdrawing a drug from the market. - are still in place in the US concerning the use of advair (seretide in the UK) for paediatric patients – those under the age of sixteen.

Going back to the highly selective beta2 agonist discussion it is interesting to note there are beta2 receptors in the heart, approximately 10% -50% of the total beta-adrenergic receptors So even highly selective beta2-agonists such as LABA’s may have cardiac effects which could become more apparent with long term use.

The example used for Intal plus was not misleading. Rather to highlight the fact that combined drugs are developed to try and kill two birds with one Neanderthal stone – clumsy metaphor – in this case a drug -Intal (sodium cromoglicate) used to dampen inflammation, though how or why was and still is anyone’s guess, combined with another drug, Isoprenaline, to relieve bronchial spasm albeit with a sledgehammer effect upon those heart receptors. (Just like oral steroids re inflammatory processes) All sounds a bit Fred Flintstoneish today, but the fact is that clinical researchers can only then, as now, use previous and current knowledge to hypothesise what might happen if…( Let alone a subsidised - in an NHS setting -research drug company’s interests)

Concerning the denial comment… meant to express a familiarity between the big M and asthma exacerbations, whether big or small - again (as per my belief in the epigenetic argument plus the extra problems women have to deal with) I truly believe there is the strongest link possible between asthma symptoms and hormones, whether one’s asthma started early on in life like mine did, or, as does for others, later on in life, for example during the menopause.

I have to keep a daily peak flow diary and the standing joke between me and the respiratory doc is ‘spot that week’re plummeting pf’s. Last week 0.50 pf despite massive inhaler and pred use and associated uncontrollable symptoms and unscheduled visit All becoming variable by the month (s).

In the past symbicort has helped me avoid long periods of time not attached to continuous oral steroids, especially during the first year to eighteen months of use.

Again can only comment from a personal patient perspective.

The research for this drug and similar either combined or separate concerning cardiac side effects needs to be further investigated especially for those of us who are not quite so young and having used this type of drug for longer than those people in clinical trials.

Mia

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I totally agree Mia, I think you've hit the nail on the head. Half time, I think its only because of forums like this that the 'side' issues that we are talking about get taken seriously. I firmly believe that doctors (consultants) are getting more and more compartmentalised. Quote Ent doctor to me to 3 weeks ago... ""I can only talk about what happens above your clavical"" As if asthma started and stopped at the clavical. Not even to mention things that may be happening in other places. The general respiratory docs are the same. I can only talk about your breathing below your clavical..

If it wasn't for this forum I wouldn't be nearly aware of other asthma related issues.

Cheers all

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'We’re all stakeholders in our treatment for asthma and whether doctors suffering from asthma or not, it is important to listen to concerns from everyone.'

The above comment strikes me as rather directed and personal - if I did not believe in the importance of listening to the concerns of others, I would not be involved in a site like AUK at all, much less taking the time to post at such length on threads like this one.

I am not disputing anyone's personal experience, and indeed am always keen to hear the experiences of others. I see my role on this site as being partly to bring a scientific interpretation to those experiences so that others reading the site might gain a balanced and accurate view of the topics under discussion. It would be borderline negligent of me to allow a public website such as this one to give the impression that LABAs are dangerous without presenting the evidence to the contrary.

In that light, I should point out that the FDA warning re Advair in the US concerns the increased risk of severe asthma exacerbations when using salmeterol, not any association with hypertension. Subsequent analysis of the data showed that the increased risk was only present when salmeterol was used without an inhaled steroid, and salmeterol-containing drugs do not carry an equivalent warning in this country. The fact that there have been concerns raised over this issue does mean that LABAs have been very extensively studied with large scale population data for all potential adverse effects, with numbers studied in the tens of thousands.

Rereading what I have written on this topic, I don't really think there is anything more that I want to add at this time; I have presented the facts as I understand them in terms of the very extensive research and post-licensing data on this class of drugs. It is of course entirely up to the individual how they chose to interpret these facts and the healthcare decisions they make as a consquence.

Em H

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