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Drugs that increase blood pressure

Gary E Sander

A number of drugs can increase blood pressure in individual subjects by degrees that may remain within the normal range, cause overt hypertension (BP > 140/90 mmHg), or even precipitate hypertensive crises. Such blood pressure increases are often potentiated by coexisting cardiovascular conditions, renal disease, diabetes, obesity and interactions with other concomitant medications. The need to investigate for the presence of drugs that may be contributing to elevated blood pressures or impairing responses to antihypertensive medications has been emphasized, particularly in the evaluation of resistant and refractory hypertension. Antihypertensive effects of diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and b-blockers may be blunted. The drugs most commonly associated with blood pressure elevations are nonsteroidal anti-inflammatory agents, sympathomimetic amines, estrogen-containing oral contraceptives, herbal preparations such as ephedra, certain antidepressants and immunosuppressants. Although most drug-induced blood pressure increases do not, in fact, lead to hypertension, systolic and diastolic blood pressure elevations of as little as 2 mmHg lead to significant increases in the risk of cardiovascular events. When a medication with the potential to increase blood pressure is added to a patient’s therapeutic regimen, it is necessary to recognize that potential, and imperative to monitor possible changes in blood pressure even within the normal range.