What medications can cause hypertension?

Medications That Can Cause Hypertension

Many prescription medications, over-the-counter drugs, supplements, and recreational substances can increase blood pressure through various mechanisms, with effects ranging from mild to severe depending on the individual. 1

Common Medication Categories That Raise Blood Pressure

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• Can increase blood pressure by 3-5 mmHg 1, 2, 3
• Mechanism: Inhibit prostaglandin synthesis, causing sodium retention and vasoconstriction 2, 4
• Examples: naproxen, ibuprofen, celecoxib
• May antagonize the effects of many antihypertensive medications, particularly ACE inhibitors, ARBs, and diuretics 2, 4
• Note: Aspirin does not typically increase blood pressure 1, 5

Hormonal Medications

• Oral contraceptives: Can increase BP by 6/3 mmHg, especially with high estrogen doses (>50 mcg) 1, 6
• Corticosteroids (prednisone, dexamethasone): Cause fluid retention and increased cardiac output 1, 6

Central Nervous System Stimulants

• Increase BP through sympathomimetic effects 1, 6
• Examples:
  • ADHD medications (methylphenidate, amphetamines, dexmethylphenidate) 6
  • Decongestants (pseudoephedrine, phenylephrine) 1, 6
  • Caffeine in high doses 6

Antidepressants

• Selective norepinephrine and serotonin reuptake inhibitors (SNRIs): Increase BP by approximately 2/1 mmHg 1, 6
• Tricyclic antidepressants: Increase odds of hypertension by 3.19 1, 6
• Note: Selective serotonin reuptake inhibitors (SSRIs) generally do not increase blood pressure 1

Other Prescription Medications

• Calcineurin inhibitors (cyclosporine, tacrolimus) 1, 7
• Angiogenesis inhibitors and tyrosine kinase inhibitors (bevacizumab, sunitinib, sorafenib) 1, 6
• Erythropoietin 1, 7
• Antimigraine serotonergics 1
• 11β-hydroxysteroid dehydrogenase type 2 inhibitors 1

Over-the-Counter Medications

• Acetaminophen: Daily use associated with increased relative risk (1.34) of hypertension 1
• Cold medications containing decongestants 1

Supplements and Herbal Products

• Ephedra (ma huang): Contains ephedrine and caffeine 1, 6
• Licorice: Mimics mineralocorticoid excess 1, 6
• Ginseng (at high doses) 1, 6
• St. John's Wort (especially with MAO inhibitors) 1, 6
• Yohimbine 1, 6

Recreational Substances

• Alcohol 1, 6
• Stimulants: cocaine, amphetamines, methamphetamine 1, 6
• Anabolic steroids 1

Mechanisms of Blood Pressure Elevation

Different medications raise blood pressure through various mechanisms:

1. Sodium and fluid retention: Corticosteroids, NSAIDs, estrogens 1, 2
2. Increased sympathetic activity: Stimulants, decongestants, SNRIs 6
3. Vasoconstriction: Decongestants, some antidepressants 6
4. Interference with antihypertensive medications: NSAIDs can reduce efficacy of ACE inhibitors, ARBs, and diuretics 2, 4
5. Mineralocorticoid effects: Licorice, some steroids 1, 6

High-Risk Patient Populations

The following patients are at higher risk for medication-induced hypertension:

• Elderly patients 1, 6
• Patients with pre-existing hypertension 6, 2
• Patients with renal disease 6
• Patients with cardiovascular disease 2, 3
• Patients taking multiple medications that can raise blood pressure 6

Clinical Pearls and Pitfalls

• Variable response: The blood pressure effect of these medications can vary significantly between individuals 1
• Calcium channel blockers appear to be the antihypertensive class least affected by NSAIDs and may be preferred in patients requiring both types of medication 4
• Monitoring: Regular blood pressure monitoring is essential when starting medications known to increase blood pressure 6
• Idiosyncratic responses: Some patients may experience severe hypertension even with appropriate dosing of medications like decongestants 1
• Discontinuation: In most cases, blood pressure returns to baseline after discontinuing the offending medication 6

By identifying and managing medications that can raise blood pressure, clinicians can improve blood pressure control and reduce cardiovascular risk in their patients.