Optimizing medication regimens by reducing or replacing medications that may increase blood pressure (BP) may improve BP control in patients with hypertension, according to a research letter published in JAMA Internal Medicine.

To understand how prevalent the use of BP-raising medications is among patients with hypertension, the researchers examined data from the National Health and Nutrition Examination Survey (NHANES). Five survey cycles were included in the analysis spanning from 2009 to 2018; participants were at least 18 years of age and were not pregnant.

Among the 27,599 adults included in the analysis (median age 46.9 years; 50.9% women), 49.2% had hypertension and 35.4% had uncontrolled hypertension. Survey results showed that 18.5% (95% CI, 17.5-19.5) of patients with hypertension reported taking a medication that could increase BP. These included antidepressants (8.7%; 95% CI, 8.0-9.5), prescription nonsteroidal anti-inflammatory drugs (NSAIDs) (6.5%; 95% CI, 5.8-7.2), steroids (1.9%; 95% CI, 1.6-2.1), and estrogens (1.7%; 95% CI, 1.4-2.0).

The use of BP-elevating medications was associated with both greater odds of uncontrolled hypertension in adults not currently on antihypertensive drugs (odds ratio, 1.24; 95% CI, 1.08-1.43), as well as greater antihypertensive use in patients with controlled and uncontrolled hypertension.


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“Clinicians caring for patients with hypertension should routinely screen for medications that may cause elevated BP and consider deprescribing, replacing them with safer therapeutic alternatives, and minimizing the dose and duration of use when alternatives are not available,” the researchers concluded.

Reference

Vitarello JA, Fitzgerald CJ, Cluett JL; et al. Prevalence of medications that may raise blood pressure among adults with hypertension in the United States. Published online November 22, 2021. JAMA Internal Medicine. doi:10.1001/jamainternmed.2021.6819.