Common Medications and Substances that May Induce Hypertension

Nearly one-third of the United States population suffers from hypertension (HTN), or elevated blood pressure (BP).¹ Although this chronic condition can be effectively managed with pharmacologic therapy and lifestyle modification, a large portion of patients still have uncontrolled BP. Research has found that 58% of patients may have uncontrolled BP due to the use of medications or substances that either induce HTN or decrease the effectiveness of an antihypertensive drug.

Because BP has a significant impact on cardiovascular health, it is essential for clinicians to be able to identify medications that can induce or cause HTN.¹ A recent article by Lovell and Ernst review the mechanisms by which medications can induce HTN as well as the strategies that should be used to manage it.

The three major mechanisms by which medications induce HTN are volume retention, sympathomimetic activation, and direct vasoconstriction.¹ Table 1 summarizes all three mechanisms and the classes of medications associated with each.

In addition to the medication classes listed in Table 1, substances such as dietary supplements, erythropoietin (EPO), and alcohol have also been found to induce HTN.¹ Each of these classes or substances act through varying or unknown mechanisms. Dietary supplements such as ephedra, bitter orange, and licorice have been found to raise systolic blood pressure (SBP) up to 10 mmHg.  EPO has not only been found to induce HTN in 20-30% of patients, but also causes higher elevations in BP in dialysis patients compared to predialysis patients. Alcohol can also induce HTN and has been found to have a dose-dependent effect on both SBP and diastolic blood pressure (DBP). Interestingly, in patients with HTN, alcohol has been found to decrease BP in the first 4 hours after being consumed but increase it 10-15 hours after ingestion.  

Fortunately, drug-induced HTN is both reversible as well as manageable.¹ Figure 1 depicts the approach that is recommended to manage drug-induced HTN. Although the strategies for treating drug-induced HTN vary according to the underlying mechanism causing it, the first step in the process is always to weigh the risk versus benefit of the offending medication. Lovell and Ernst urge providers to determine the necessity of the medication and assess the possibility of switching to another agent or decreasing the dose of the instigating medication if possible.

Medications can induce HTN through a variety of mechanisms such as volume retention, sympathomimetic activation, and direct vasoconstriction.¹ Because BP significantly impacts cardiovascular health, it is important for providers to be able to identify medications that induce HTN and the strategies that should be used to treat it. 

References

1.      Lovell AR, Ernst ME. Drug-Induced Hypertension: Focus on Mechanisms and Management. Curr Hypertens Rep. 2017; 19: 39.