Can montelukast increase blood pressure?

Montelukast and Blood Pressure: Clinical Implications

Montelukast is not listed among medications known to increase blood pressure according to current hypertension guidelines. 1

Evidence from Hypertension Guidelines

The International Society of Hypertension's 2020 guidelines provide a comprehensive list of medications and substances known to exacerbate or induce hypertension, including:

• NSAIDs (3/1 mmHg increase with nonselective NSAIDs) 1
• Combined oral contraceptive pills (6/3 mmHg increase with high-dose estrogen) 1
• Antidepressants (particularly SNRIs and tricyclics) 1
• Acetaminophen (with almost daily use) 1
• Other medications (steroids, sympathomimetics, antimigraine serotonergics, etc.) 1
• Herbal substances (alcohol, ma-huang, high-dose ginseng, licorice, etc.) 1

Notably, montelukast (a leukotriene receptor antagonist) is not included in this list of medications known to increase blood pressure 1.

Rare Case Reports and Research Findings

While montelukast is generally not associated with blood pressure elevation, there are some important considerations:

• A rare case report documented montelukast-induced hypercholesterolemia, severe hypertriglyceridemia, and pancreatitis in a 22-year-old male patient after 2 months of therapy 2
• This metabolic disturbance could theoretically affect cardiovascular risk factors, though direct hypertensive effects were not specifically reported 2

Potential Cardiovascular Benefits

Some research actually suggests potential cardiovascular benefits of montelukast:

• A nationwide cohort study found montelukast was associated with lower risk for recurrent stroke (HR 0.62; 95% CI 0.38-0.99) and recurrent myocardial infarction in males (HR 0.65; 95% CI 0.43-0.99) 3
• Another study showed asthmatic patients receiving montelukast had significantly lower serum C-reactive protein and improved lipid profiles compared to placebo 4
• Recent animal research suggests montelukast may actually ameliorate hypertension-induced endothelial dysfunction in experimental models 5

Clinical Implications and Monitoring

When prescribing montelukast:

• Regular monitoring of lipid profiles is recommended for patients on long-term montelukast therapy, as rare metabolic effects have been reported 2
• Be vigilant for unusual weight gain or abdominal pain in patients taking montelukast, as these could indicate rare metabolic complications 2
• Consider montelukast's potential cardiovascular benefits when selecting therapy for asthmatic patients with cardiovascular risk factors 3, 4

Conclusion

Based on current hypertension guidelines and available evidence, montelukast is not recognized as a medication that typically increases blood pressure 1. In fact, some research suggests it may have cardiovascular protective effects 3, 4, 5. However, clinicians should remain vigilant for rare metabolic complications that could indirectly affect cardiovascular risk 2.