From the Guidelines
Citalopram is not directly associated with causing hypertension, but it can interact with other medications that may increase blood pressure. When considering the potential effects of citalopram on blood pressure, it's essential to examine the available evidence. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, citalopram may have various side effects, but hypertension is not explicitly mentioned as a common concern. Some key points to consider when prescribing citalopram include:
- Citalopram may cause QT prolongation associated with Torsade de Pointes, ventricular tachycardia, and sudden death at daily doses exceeding 40 mg/d 1
- Citalopram has a lower propensity for drug interactions compared to other SSRIs, as it has the least effect on CYP450 isoenzymes 1
- A conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs like citalopram 1 It's crucial to monitor patients for potential side effects, including changes in blood pressure, especially during the initial weeks of treatment or when adjusting dosages. If hypertension becomes a concern, healthcare providers may need to adjust the dosage or consider alternative medications.
From the FDA Drug Label
Cardiovascular – Frequent: tachycardia, postural hypotension, hypotension. Infrequent: hypertension, bradycardia, edema (extremities), angina pec toris, extrasystoles, cardiac failure, flushing, myocardial infarction, cerebrovascular accident, myocardial ischemia.
Citalopram can cause hypertension, although it is listed as an infrequent adverse event. This suggests that while it is not a common side effect, it is still a possible risk associated with citalopram treatment 2.
From the Research
Citalopram and Hypertension
- The study 3 found that citalopram had a beneficial effect on lowering blood pressure in patients with concomitant depression and hypertension.
- After one month, diastolic blood pressure was significantly higher in the control group compared to the intervention group, and after two months, both systolic and diastolic blood pressure were significantly decreased in the intervention group.
- There is no evidence to suggest that citalopram causes hypertension, and in fact, the study 3 suggests that it may have a positive effect on blood pressure control.
Safety of Citalopram
- The study 4 found that citalopram is safe for patients with depression, with few drugs interacting with it in a clinically meaningful way.
- The study 4 also found that citalopram did not increase the risk of suicide, overdose, seizure, or arrhythmia.
- The study 5 found that citalopram dosages exceeding 40 mg/day were not associated with an increased risk of ventricular arrhythmia or mortality.
Hypertension Treatment
- The study 6 discussed the use of beta-blockers and ACE inhibitors in combination for the treatment of hypertension and cardiovascular disease.
- The study 7 highlighted the importance of selecting antihypertensive therapies based on the presence of concomitant cardiovascular and metabolic conditions, as well as patient-specific factors.
- The study 7 also suggested that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers may offer benefits beyond simple blood pressure lowering.