Can Lexapro Elevate Blood Pressure?
No, Lexapro (escitalopram) does not typically cause hypertension and is considered one of the safest antidepressants for blood pressure control. According to the 2020 International Society of Hypertension guidelines, selective serotonin reuptake inhibitors (SSRIs) like Lexapro do not increase blood pressure, unlike other antidepressant classes 1.
Evidence on Lexapro and Blood Pressure
The relationship between Lexapro and blood pressure is well-documented:
SSRI classification: Lexapro belongs to the SSRI class, which is specifically noted in hypertension guidelines as having "no increases in blood pressure" compared to other antidepressant types 1.
Clinical evidence: A 2019 study examining escitalopram in hypertensive patients with depression found no significant changes in systolic blood pressure (140.80 ± 16.48 vs 139.61 ± 18.92 mmHg, p = 0.85) or diastolic blood pressure (80.55 ± 12.64 vs 80.18 ± 16.36 mmHg, p = 0.94) 2.
FDA labeling: The FDA drug label for escitalopram mentions hypertension only as a potential rare effect in overdose situations, not as a common side effect with therapeutic dosing 3.
Comparison with Other Antidepressant Classes
When considering antidepressant options for patients with hypertension concerns:
| Antidepressant Class | Effect on Blood Pressure |
|---|---|
| SSRIs (including Lexapro) | No significant increase [1] |
| SNRIs | 2/1 mmHg average increase [1] |
| Tricyclic Antidepressants | Increased odds ratio of 3.19 for hypertension [1] |
Clinical Implications
For patients with both depression and hypertension or cardiovascular concerns:
First-line option: SSRIs like Lexapro are generally considered the safest antidepressant choice for patients with hypertension or cardiovascular disease 4.
Monitoring: While not typically necessary due to blood pressure concerns alone, routine BP monitoring is reasonable when starting any new medication.
Potential benefits: Some research even suggests that in hypertensive patients with depression, adding citalopram (a similar SSRI) to antihypertensive therapy may improve blood pressure control compared to antihypertensive therapy alone 5.
Important Caveats
Individual variation: While population studies show no significant effect on blood pressure, individual responses can vary.
Overdose situations: In overdose, Lexapro can potentially cause hypertension, though hypotension is also possible 3.
Drug interactions: When considering Lexapro in patients with hypertension, be aware of potential interactions with other medications that might independently affect blood pressure.
In conclusion, Lexapro is unlikely to elevate blood pressure in most patients and represents one of the safer antidepressant options for patients with hypertension or cardiovascular concerns.