What categories of medications can increase blood pressure?

Medication Categories That Can Increase Blood Pressure

Multiple medication categories can increase blood pressure, including NSAIDs, antidepressants, decongestants, oral contraceptives, steroids, immunosuppressants, stimulants, and certain herbal supplements. 1

Major Medication Categories That Increase Blood Pressure

High Impact Medications

• Decongestants containing sympathomimetics like phenylephrine and pseudoephedrine can significantly raise blood pressure through vasoconstriction 1, 2
• Stimulants used for ADHD (amphetamines, methylphenidate) can increase blood pressure through sympathetic stimulation 1
• Oral contraceptives, especially those with high doses of estrogen (>50 mcg), can increase blood pressure by 6/3 mmHg 1
• Steroids (glucocorticoids) can cause fluid retention and increase blood pressure 1, 3
• Herbal supplements including ma-huang (ephedra), high-dose ginseng, licorice, St. John's wort, and yohimbine can elevate blood pressure 1

Moderate Impact Medications

• NSAIDs (non-selective and COX-2 inhibitors) can increase blood pressure by approximately 3/1 mmHg and antagonize the effects of many antihypertensive medications, particularly RAAS inhibitors and beta-blockers 1
• Antidepressants, particularly SNRIs (selective norepinephrine and serotonin reuptake inhibitors) can increase blood pressure by 2/1 mmHg, while tricyclic antidepressants have an increased odds ratio of 3.19 for hypertension 1, 4
• Acetaminophen with almost daily use has an increased relative risk of 1.34 for hypertension 1
• Immunosuppressants, particularly calcineurin inhibitors (cyclosporine, tacrolimus), can raise blood pressure 1, 5

Other Medications That Can Increase Blood Pressure

• Monoamine oxidase inhibitors (MAOIs) can cause severe hypertensive crisis, especially when combined with tyramine-containing foods or sympathomimetic drugs 2, 6
• Antimigraine serotonergics can increase blood pressure 1
• Recombinant human erythropoietin commonly causes hypertension that requires intensification of antihypertensive therapy 1, 5
• Antiangiogenesis and kinase inhibitors used in cancer treatment can elevate blood pressure 1
• 11β-hydroxysteroid dehydrogenase type 2 inhibitors can cause hypertension 1

Drug Interactions That Potentiate Blood Pressure Elevation

• Combination effects: When sympathomimetics like phenylephrine are combined with MAOIs, β-blockers, α-2 adrenergic agonists, steroids, tricyclic antidepressants, or ergot alkaloids, the pressor effect is significantly increased 2
• Alcohol can acutely raise blood pressure and interfere with antihypertensive medications 1
• Illicit drugs, especially cocaine and amphetamines, can cause severe hypertension 1, 5

Clinical Implications and Management

• Screen all patients with hypertension for medications and substances that may increase blood pressure 1
• Consider alternative medications when possible (e.g., SSRIs instead of SNRIs or tricyclics; acetaminophen instead of NSAIDs for occasional use) 1, 4
• When hypertensive medications cannot be avoided, blood pressure should be monitored more frequently and antihypertensive therapy adjusted accordingly 1
• The effect of these substances on blood pressure can vary significantly between individuals, with greater increases noted in elderly patients, those with higher baseline blood pressure, patients already on antihypertensive therapy, or those with kidney disease 1

Special Considerations

• Individual variability: The blood pressure response to these medications can vary widely between patients 1
• Dose-dependent effects: Higher doses of medications like stimulants, decongestants, and steroids generally cause more pronounced blood pressure elevations 3
• Temporary vs. chronic effects: Some medications cause acute increases in blood pressure (e.g., decongestants), while others lead to sustained hypertension with chronic use (e.g., NSAIDs, oral contraceptives) 1