Medications that increase blood pressure
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Medications That Increase Blood Pressure
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Blood Pressure
NSAIDs and Hypertension
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used medications that can significantly increase blood pressure. Studies have shown that NSAIDs can elevate blood pressure in both normotensive and hypertensive individuals. Meta-analyses indicate that NSAID use can lead to an average increase in mean blood pressure of about 5 mm Hg, with the effect being more pronounced in patients with controlled hypertension 13. Specific NSAIDs such as piroxicam, naproxen, and indomethacin have been identified as having the greatest impact on blood pressure, while sulindac has the smallest effect .
Mechanisms of NSAID-Induced Hypertension
The mechanisms by which NSAIDs increase blood pressure include sodium retention, extracellular volume expansion, and increased total peripheral vascular resistance. These effects are thought to be mediated through the inhibition of prostaglandin synthesis, which affects renal function and vascular tone 15. The interaction between NSAIDs and antihypertensive medications can also reduce the efficacy of the latter, particularly beta-blockers, while calcium channel blockers seem to be less affected 59.
Antidepressants and Blood Pressure
Impact of Antidepressants on Blood Pressure
Antidepressant medications can also influence blood pressure, often through their effects on the autonomic nervous system. Selective serotonin reuptake inhibitors (SSRIs) generally have a limited impact on blood pressure and are considered safer for patients with cardiovascular conditions. However, serotonin-norepinephrine reuptake inhibitors (SNRIs), particularly venlafaxine, are associated with a higher risk of hypertension due to their stronger effects on the sympathetic nervous system . Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) can also cause significant blood pressure increases, sometimes leading to hypertensive crises .
Mechanisms of Antidepressant-Induced Hypertension
The hypertensive effects of antidepressants are primarily due to their action on adrenergic and serotoninergic pathways. For instance, SNRIs increase norepinephrine levels, which can lead to vasoconstriction and elevated blood pressure. Tricyclic antidepressants can block reuptake of norepinephrine and serotonin, leading to similar effects .
Other Medications That Increase Blood Pressure
Sympathomimetic Agents and Oral Contraceptives
Sympathomimetic agents, often found in decongestants and weight loss medications, can directly stimulate the sympathetic nervous system, leading to increased heart rate and blood pressure. Estrogen-containing oral contraceptives are also known to elevate blood pressure, particularly in women with preexisting hypertension or other cardiovascular risk factors .
Immunosuppressants and Herbal Preparations
Certain immunosuppressants, such as cyclosporine, can cause significant blood pressure increases through mechanisms involving renal vasoconstriction and sodium retention. Herbal preparations containing ephedra or other stimulants can also elevate blood pressure and should be used with caution .
Conclusion
A variety of medications, including NSAIDs, antidepressants, sympathomimetic agents, and certain oral contraceptives, can increase blood pressure through different mechanisms. It is crucial for healthcare providers to monitor blood pressure in patients taking these medications, especially those with preexisting hypertension or cardiovascular conditions. Where possible, alternative treatments with a lower risk of increasing blood pressure should be considered.
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