Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Drug-induced hypertension
Many therapeutic agents can cause either a transient or persistent increase in blood pressure. This secondary hypertension (HT) may present as new-onset HT or exacerbation of existing HT, or as difficult to treat HT. It is important to assess the risk for each patient on an individual basis.
- Some factors that might increase a patient’s risk for these drugs to increase their BP include the dose of the drug taken, the patient’s current blood pressure control, their co-morbidities, other medicines and the individual risk of each drug.
- With NSAIDs including cyclooxygenase 2 inhibitors, meta-analysis shows an average increase in systolic blood pressure (SBP) of 5 mm Hg in patients without HT and up to 14 mm Hg in those with existing HT. Inhibited of prostaglandin synthesis by NSAIDs reduces vasodilatory & natriuretic effects. Increased sodium & water retention activates the renin-angiotensin-aldosterone system (RAAS), increasing BP & attenuating antihypertensive effects of ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers and diuretics.
- Antidepressants including venlafaxine, desvenlafaxine and reboxetine commonly cause HT through increased synaptic levels of serotonin and/or noradrenaline. HT related to monoamine oxidase inhibitors is usually associated with ingestion of tyrosine rich foods.
- Complementary therapies are also implicated. Liquorice, which may be present in tobaccoless smoke, increases cortisol and fluid retention. Ephedra alkaloids and yohimbine are adrenergic stimulants. Others agents that have been reported to increase HT include coenzyme Q10, olive leaf, ginger, and Ma huang. Ginseng has been reported to cause both increased and reduced blood pressure.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.