What medications can cause blood pressure (BP) fluctuations?

Medications That Can Cause Blood Pressure Fluctuations

Numerous prescription medications, over-the-counter medications, herbal supplements, and substances can cause blood pressure elevations or interfere with blood pressure control. 1 Understanding these agents is essential for proper management of hypertension.

Common Medications That Can Raise Blood Pressure

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• NSAIDs can increase blood pressure by 3/1 mmHg on average and can antagonize the effects of RAAS inhibitors and beta blockers 1
• They can cause sodium retention, reduce the effectiveness of diuretics, and impair renal function 2
• NSAIDs should be avoided when possible in patients with hypertension, with acetaminophen being a potentially safer alternative (though it may also slightly increase hypertension risk) 1

Decongestants and Sympathomimetics

• Pseudoephedrine, phenylephrine, and other sympathomimetics can significantly raise blood pressure 1
• Alternative therapies such as nasal saline, intranasal corticosteroids, or antihistamines should be considered for patients with hypertension 1
• Amphetamines and related stimulants (including those used for ADHD) can cause substantial blood pressure elevations 1

Antidepressants

• Selective norepinephrine and serotonin reuptake inhibitors (SNRIs) can increase blood pressure by approximately 2/1 mmHg 1
• Tricyclic antidepressants have been associated with a 3.19 increased odds ratio of hypertension 1
• Monoamine oxidase inhibitors (MAOIs) can cause significant blood pressure elevations, especially when combined with tyramine-containing foods 1
• SSRIs generally do not increase blood pressure and may be safer alternatives 1

Hormonal Medications

• Oral contraceptives can increase blood pressure by 6/3 mmHg, especially with higher doses of estrogen (>50 mcg) 1
• Low-dose formulations (20-30 mcg ethinyl estradiol) or progestin-only contraceptives are preferred for women with hypertension 1
• Steroids and other hormonal treatments can also cause blood pressure elevations 1

Other Prescription Medications

• Immunosuppressants (especially cyclosporine) can significantly raise blood pressure 1
• Antipsychotics, particularly atypical agents like clozapine and olanzapine, may cause hypertension 1
• Certain cancer treatments, including antiangiogenesis and kinase inhibitors, can elevate blood pressure 1
• Calcineurin inhibitors commonly used after transplantation can cause hypertension 1

Substances and Over-the-Counter Products

Alcohol

• Regular alcohol consumption can raise blood pressure, with recommendations to limit intake to ≤1 drink daily for women and ≤2 drinks for men 1
• Alcohol can also reduce the effectiveness of antihypertensive medications 1

Caffeine and Energy Drinks

• Caffeine can cause acute increases in blood pressure, though long-term effects are less clear 1
• Limiting caffeine intake to <300 mg/day is generally recommended for patients with hypertension 1
• Energy drinks containing multiple stimulants may have more pronounced effects on blood pressure 1

Herbal Supplements

• Ma Huang (ephedra), ginseng (at high doses), licorice, St. John's wort, and yohimbine can all raise blood pressure 1
• These supplements should be avoided in patients with hypertension 1

Management Strategies

For Patients Taking BP-Raising Medications

• When possible, discontinue or reduce the dose of medications that raise blood pressure 1
• Consider alternative agents with less impact on blood pressure 1
• If the medication cannot be discontinued, adjust antihypertensive therapy to counteract the BP-raising effects 1

For Healthcare Providers

• Perform a thorough medication review for all patients with new-onset or resistant hypertension 3
• Be aware that approximately 18% of patients with hypertension are prescribed medications that can interfere with blood pressure control 3
• Monitor blood pressure closely when starting medications known to raise BP 2

Special Considerations

Seasonal Variations

• Blood pressure naturally varies with temperature, with higher readings in cold weather and lower readings in warm weather (average decline of 5/3 mmHg in summer) 1
• This may affect medication requirements and should be considered when evaluating blood pressure control 1

Individual Variability

• The effect of medications on blood pressure can vary significantly between individuals 1
• Elderly patients, those with pre-existing hypertension, and those with renal impairment are at higher risk for drug-induced hypertension 4

By identifying and addressing medications and substances that can raise blood pressure, clinicians can improve blood pressure control and reduce the need for additional antihypertensive medications in many patients.