Can gabapentin lower blood pressure
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Gabapentin and Its Effects on Blood Pressure
Introduction to Gabapentin and Blood Pressure
Gabapentin, a ligand of the α2δ subunit of voltage-dependent calcium channels (VDCCs), is primarily used to treat neuropathic pain and partial seizures. Recent research has explored its potential effects on blood pressure (BP), particularly in hypertensive conditions. This article synthesizes findings from multiple studies to determine whether gabapentin can lower blood pressure.
Acute Effects of Gabapentin on Blood Pressure
Hemodynamic Response in Hypertensive Rats
Several studies have demonstrated that acute administration of gabapentin can significantly lower blood pressure in spontaneously hypertensive rats (SHR). One study found that gabapentin reduced BP and heart rate more in SHR compared to normotensive Wistar-Kyoto rats. This effect was linked to a decrease in plasma norepinephrine levels and a reduction in peripheral sympathetic nerve transmission 13. Another study highlighted that gabapentin's hypotensive effect was mediated through the nucleus tractus solitarii (NTS) and involved nitric oxide synthase (NOS) signaling pathways 2.
Sympathetic Nervous System Involvement
Gabapentin's ability to lower BP is partly due to its impact on the sympathetic nervous system. It was observed that gabapentin, similar to the N-type VDCC blocker ω-conotoxin GVIA, abolished the nitroprusside-induced reflex tachycardia and reduced the pressor response of the mesenteric vascular bed to nerve stimulation 13. These findings suggest that gabapentin can modulate sympathetic control of BP, contributing to its acute hypotensive effects.
Chronic Effects of Gabapentin on Blood Pressure
Long-Term Administration and Cardiovascular Function
While acute administration of gabapentin has shown promising results in lowering BP, its chronic effects appear to be less significant. One study indicated that chronic gabapentin treatment did not sustain the initial BP-lowering effects observed with acute administration 1. Additionally, chronic treatment was associated with hypotension, bradycardia, and left ventricular systolic dysfunction in rats, suggesting potential adverse cardiovascular effects 9.
Gabapentin in Clinical Settings
Attenuation of Pressor Response During Surgery
Gabapentin has also been studied for its effects on BP during surgical procedures. In normotensive patients undergoing elective surgery, gabapentin administered before anesthesia significantly blunted the increase in BP and heart rate associated with tracheal intubation 57. This suggests that gabapentin can be effective in managing acute hypertensive responses in clinical settings.
Effects in Cats
Interestingly, studies on cats have shown that gabapentin did not significantly affect systolic arterial BP in either at-home or in-clinic environments, although it did improve compliance and reduce anxiety during cardiac evaluations 68. This indicates that gabapentin's effects on BP may vary across different species and contexts.
Conclusion
In summary, gabapentin has been shown to lower blood pressure acutely in hypertensive rats, primarily through modulation of the sympathetic nervous system and involvement of NOS signaling pathways. However, its chronic administration does not maintain these hypotensive effects and may lead to adverse cardiovascular outcomes. In clinical settings, gabapentin can effectively attenuate acute hypertensive responses during surgical procedures. Further research is needed to fully understand the long-term cardiovascular implications of gabapentin use.
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