From the Guidelines
Yes, ecstasy (MDMA) does increase blood pressure, as it triggers the release of neurotransmitters like norepinephrine, dopamine, and serotonin, which activate the sympathetic nervous system, leading to an acute elevation in blood pressure, along with increased heart rate and body temperature, within 30-60 minutes of ingestion 1.
Key Points to Consider
- The blood pressure increase can be significant, with systolic pressure rising by 25-40 mmHg and diastolic by 10-20 mmHg in many users.
- These cardiovascular effects are particularly dangerous for people with pre-existing hypertension, heart conditions, or those taking certain medications like MAOIs.
- The risk increases with higher doses, when combined with other stimulants like cocaine or amphetamines, or in hot environments like dance clubs where dehydration and overheating can further stress the cardiovascular system.
Relevant Evidence
- A study published in the journal Stroke in 2014 found that drugs of abuse, including MDMA, are associated with an increased risk of stroke and can produce acute severe BP elevations, cerebral vasospasm, vasculitis, embolization resulting from infective endocarditis, endothelial dysfunction, hemostatic and hematological abnormalities resulting in increased blood viscosity and platelet aggregation, and intracerebral hemorrhage 1.
- Another study published in the Journal of the American College of Cardiology in 2021 discussed the cardiovascular actions of cocaine and methamphetamine, which are similar to those of MDMA, and can lead to myocardial ischemia, infarction, and hypertensive vascular catastrophes 1.
Clinical Implications
- It is essential to consider the potential cardiovascular risks associated with ecstasy use, particularly in individuals with pre-existing medical conditions or those taking certain medications.
- Healthcare professionals should be aware of the signs and symptoms of ecstasy-induced hypertension and be prepared to manage potential complications.
From the Research
Ecstasy and Blood Pressure
- Ecstasy, also known as 3,4-methylenedioxymethamphetamine (MDMA), is a powerful sympathetic stimulant that may increase blood pressure 2.
- A double-blind, placebo-controlled trial found that MDMA increased mean heart rate, systolic blood pressure, diastolic blood pressure, and cardiac output in healthy adults 3.
- The study found that at a dose of 1.5 mg/kg, MDMA increased systolic blood pressure by 25 mm Hg and diastolic blood pressure by 7 mm Hg 3.
Cardiovascular Effects of Ecstasy
- Ecstasy has been reported to cause acute systolic heart failure and non-ischemic cardiomyopathy in a young female, highlighting the potential acute harmful effects of MDMA on cardiac function and viability 4.
- Hyperthermia, a major side effect of MDMA, can severely affect the vascular effects of MDMA and its metabolites, leading to increased cardiovascular risk 5.
- A study found that MDMA and its metabolites can exert vasoconstriction of the human internal mammary artery, which is considerably higher in hyperthermic conditions 5.
Interaction with Beta-Blockers
- Beta-blockers may prevent increases in heart rate but not hypertensive effects of MDMA 6.
- A double-blind placebo-controlled crossover study found that the non-selective beta-blocker pindolol prevented MDMA-induced increases in heart rate but had no effect on increases in mean arterial blood pressure 6.