Is Kratom use safe for individuals with hypertension?

Kratom Use and Hypertension: Safety Concerns

Kratom use is not recommended for individuals with hypertension due to its documented effects of causing hypertension and tachycardia, which can worsen blood pressure control and increase cardiovascular risk.

Cardiovascular Effects of Kratom

Kratom (Mitragyna speciosa) has been associated with several adverse cardiovascular effects that make it particularly concerning for individuals with hypertension:

• Acute blood pressure elevation: Kratom has been documented to cause hypertension and tachycardia as common adverse cardiovascular effects 1
• Cardiovascular toxicity: Case reports have linked kratom use to serious cardiovascular complications including:
  • Ventricular arrhythmia
  • Cardiopulmonary arrest
  • Coronary atherosclerosis
  • Myocardial infarction
  • Cardiomegaly and cardiomyopathy 1

Hypertension Management Guidelines and Substance Use

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines specifically address substances that may cause elevated blood pressure. While kratom is not explicitly listed in these guidelines, the recommendations for similar substances are relevant:

• The ACC/AHA guidelines recommend avoiding substances that can elevate blood pressure, particularly in patients with uncontrolled hypertension 2
• The guidelines specifically advise discontinuation or avoidance of recreational drugs that can raise blood pressure 2
• For substances that cause hypertension, the recommended management strategy is to "discontinue or avoid use" 2

Risk Factors and Considerations

Several factors increase the risk associated with kratom use in hypertensive individuals:

1. Dose-dependent effects: Higher doses of kratom appear to correlate with greater cardiovascular risk 1

2. Polysubstance use: The risk of adverse cardiovascular effects significantly increases when kratom is combined with other substances 1, 3

3. Unpredictable composition: Kratom products vary widely in composition and potency, with more than 40 different alkaloids identified in the plant 4

4. Limited clinical research: There is insufficient controlled human research on kratom's safety profile in hypertensive patients 3

Alternative Approaches for Hypertensive Individuals

For hypertensive individuals seeking alternatives to kratom for pain management or other purposes, the following evidence-based approaches are recommended:

• Lifestyle modifications as recommended by the 2020 International Society of Hypertension guidelines:

  • Regular aerobic and resistance exercise
  • Maintaining healthy body weight
  • Following a Mediterranean or DASH diet
  • Limiting alcohol consumption
  • Avoiding tobacco use 2

• Appropriate pharmacological management of hypertension using first-line agents:

  • ACE inhibitors or ARBs
  • Dihydropyridine calcium channel blockers
  • Thiazide or thiazide-like diuretics 2

Conclusion

Given the documented cardiovascular risks of kratom, including hypertension and tachycardia, and in accordance with hypertension management guidelines that recommend avoiding substances that elevate blood pressure, kratom use should be avoided by individuals with hypertension. The unpredictable nature of kratom products and limited clinical research further support this recommendation.