Are other medications raising your blood pressure?
Courtesy of Metro Creative
A new report from the National Health and Nutrition Examination Survey shows high blood pressure can actually be worsened by commonly used prescription medications as well as over the counter medicines.
Dr. Indu Poornima
Nearly half of American adults have high blood pressure, also known as hypertension, or are taking medication for the condition.
There may be other medications, however, that many adults take that could be raising their blood pressure.
A new report from the National Health and Nutrition Examination Survey (NHANES) shows high blood pressure can actually be worsened by commonly used prescription medications as well as over the counter medicines. The most common culprits appear to be antidepressants along with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
The survey reported nearly one in five American adults with hypertension is on a prescription drug known to raise blood pressure. The findings are based on analysis of nearly 28,000 American adults between 2009-2018 and focused on the 44% who either had an average blood pressure measurement of at least 130/80 mm Hg or reported having been diagnosed with hypertension.
The survey looked at prescription medications taken by each participant and the results showed 24% of women and 14% of men were taking at least one prescription drug known to raise blood pressure. Of those surveyed, 4% were taking two or more of these agents.
The researchers based their identification of pressure-increasing prescription drugs on a list created by the American College of Cardiology and the American Heart Association that includes monoamine oxidase inhibitors, serotonin norepinephrine reuptake inhibitors and tricyclic antidepressants. In the study, antidepressants accounted for 8.7% of the medications shown to cause high blood pressure, followed by NSAIDs at 6.5%, steroids at 1.9% and estrogens at 1.7%.
Researchers concluded that use of these prescriptions could be what stands in the way of almost 2 million Americans having their hypertension under control.
Dr. Indu Poornima, cardiologist and director of Allegheny Health Network’s Women’s Heart Center, said this problem is surprisingly widespread.
“It is not uncommon, especially the use of NSAIDS for pain control and decongestants for sinus infections,” Poornima said. “The lack of awareness both in the medical community and the public is significant. Certain antidepressants are often prescribed without much attention to patients’ underlying risk factors. Hypertension is not often a consideration since the incidence is not greater than 10%, but for an individual patient it may make a difference.”
This study did not look at over the counter drug use, but the reports authors warn they may be a factor for many patients. The report also concludes keeping hypertensive patients on certain other medications known to raise blood pressure only results in “prescribing cascades” where patients then must take more medicine to lower blood pressure.
Poornima recommended talking with a doctor about whether prescriptions may be affecting a blood pressure reading.
“Among the commonly used antidepressants, Effexor, Prozac and Elavil are known to raise blood pressure,” she said. “It is unclear if it unmasks hypertension in those who may be predisposed to it. Certainly if it is someone with a prior diagnosis of hypertension, these drugs are best avoided.
There are several alternatives among antidepressants,” she added, “and so it does not imply that the depression is not adequately addressed.”
Along with antidepressants and NSAIDs, another area of concern are prescriptions containing estrogen including birth control for women.
“Be aware of the common drug classes that can raise blood pressure,” Poornima said. “Simply taking them out could be the treatment for your hypertension versus adding several blood pressure meds. Among young women on birth control pills, the amount of estrogen in the pill could be an inciting factor for elevated blood pressure.”
As for over the counter medicines, they could raise a patient’s numbers even higher without them ever realizing it. NSAIDs are a particular area to look at because this class is also linked with an increased risk for bleeding and other adverse effects.
Minimizing the use of NSAIDs including ibuprofen and naproxen could be helpful in lower blood pressure. Doctors recommend trying alternatives such as acetaminophen.
“The main advice is to be aware that if your blood pressure suddenly becomes uncontrolled it may be due to some other medicine that is potentiating it,” Poornima said. “Before adding more blood pressure meds, go through all the meds you take with your doctor to see if there are any alternatives. Over the counter meds to be avoided include Ibuprofen (Motrin, Advil) and decongestants such as Sudafed.
Again, taking an occasional ibuprofen will not cause issues,” she added. “It is usually the regular usage of these drugs that causes problems.”