JS-ISH-ESH-1: DRUGS AND SUBSTANCES THAT INCREASE BLOOD PRESSURE

Abstract

The use of herbal medications and substances that have been touted to raise BP is increasing globally with estimates for example 6 to 48 percent of persons use herbal therapies in Europe. Other medications such as NSAIDs are among the most widely used treatments globally. Several of such medications and substances may raise blood pressure or antagonize the BP lowering effects of antihypertensive therapy in individuals. The individual effect of these substances on blood pressure can be highly variable with greater increases noted in the elderly, those with higher baseline blood pressure, use of antihypertensive therapy, and co-existing renal disease. In this discussion, we will review the evidence for the most commonly implicated substances that have been considered to raise blood pressure including NSAIDs, oral contraceptives, hormone replacement therapy, and antidepressants. We will also review the evidence for herbal therapies that may raise BP. Coxibs are associated with a 3.9 mm Hg mean increase in SBP and nonselective NSAIDs 2.8 mm Hg compared with placebo. In meta-analyses, aspirin was not associated with a significant blood pressure increase. High regular acetaminophen dosing is associated with an increased risk of new onset hypertension. Oral contraceptives were associated with new onset hypertension in approximately 5 percent of users of high dose compounds that contain at least 50 mg estrogen but these high estrogen doses are not commonly used in current formulations. SNRI antidepressants were found to have a small increase in systolic blood pressure relative to SSRI antidepressants 1.5 mmHg. Patients prescribed SSRIs showed no significant differences in blood pressure changes compared with placebo. Despite their widespread use, there are few studies on the effects of herbal substances on blood pressure apart from licorice and ephedra or ma huang. Licorice contains glycyrrhizic acid that acts as an 11 beta hydroxysteroid dehydrogenase type 2 inhibitor causing pseudohyperaldosteronism. Given the widespread use of these medications and substances, physicians will have to screen for these medications and substances when assessing patients at risk for and with hypertension.