Does gabapentin raise blood pressure
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Gabapentin and Blood Pressure: A Comprehensive Review
Introduction to Gabapentin and Blood Pressure
Gabapentin, a medication primarily used to treat neuropathic pain and epilepsy, has been studied for its effects on blood pressure (BP). This article synthesizes findings from various studies to determine whether gabapentin raises blood pressure.
Gabapentin's Effect on Blood Pressure in Hypertensive Models
Studies in Spontaneously Hypertensive Rats (SHR)
Research on spontaneously hypertensive rats (SHR) has shown that gabapentin can lower blood pressure. Acute administration of gabapentin significantly reduced BP and heart rate in SHR, more so than in normotensive Wistar-Kyoto rats. This hypotensive effect was linked to a reduction in sympathetic nerve activity, as evidenced by decreased plasma norepinephrine levels and reduced pressor response to nerve stimulation 23. Additionally, gabapentin's effect on BP was diminished in sympathectomized rats, indicating its reliance on the sympathetic nervous system 23.
Gabapentin in Clinical Settings
Hemodynamic Response During Surgery
Several studies have investigated gabapentin's impact on BP during surgical procedures, particularly during laryngoscopy and tracheal intubation, which are known to cause transient increases in BP and heart rate. Gabapentin, administered before surgery, has been shown to attenuate these hemodynamic responses. For instance, patients who received 800 mg of gabapentin one hour before surgery exhibited significantly lower arterial pressure and heart rate compared to those who received a placebo 459. Another study found that a combination of gabapentin and esmolol was more effective in blunting the pressor and tachycardic responses than either drug alone 7.
Gabapentin's Mechanism of Action on Blood Pressure
Central Nervous System Effects
Gabapentin's ability to modulate BP may also involve central mechanisms. In hypertensive rats, microinjection of gabapentin into the nucleus tractus solitarii (NTS), a key brain region for cardiovascular control, resulted in dose-related reductions in BP and heart rate. This effect was mediated through the nitric oxide synthase (NOS) signaling pathway, as it was attenuated by NOS inhibitors 8.
Gabapentin in Non-Hypertensive Models
Studies in Normotensive Subjects
In normotensive subjects, gabapentin does not appear to significantly alter BP under normal conditions. For example, a study on healthy cats found no significant differences in systolic BP between gabapentin-treated and placebo-treated groups, both in at-home and in-clinic environments 1. Similarly, in normotensive patients undergoing surgery, gabapentin did not cause significant hemodynamic changes compared to baseline values 6.
Conclusion
Overall, gabapentin does not raise blood pressure; in fact, it tends to lower BP, particularly in hypertensive models and during stress-inducing procedures like surgery. Its hypotensive effects are primarily mediated through the sympathetic nervous system and central mechanisms involving the NTS. Therefore, gabapentin may be beneficial in managing BP in specific clinical scenarios, especially where sympathetic hyperactivity is a concern.
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