Which of the following medications could contribute to hypertension: albuterol, ASA (Aspirin), Bimzelx (Bimekizumab), Buspar (Buspirone), carvedilol, vitamin D, Farxiga (Dapagliflozin), duloxetine, famotidine, HCTZ (Hydrochlorothiazide), Xyzal (Levocetirizine), lisinopril, methocarbamol, Singulair (Montelukast), Protonix (Pantoprazole), Lyrica (Pregabalin), quetiapine, upadacitinib, and vortioxetine?

Medications That Could Contribute to Hypertension

Among the listed medications, duloxetine, albuterol, quetiapine, and upadacitinib are the primary contributors to hypertension, while carvedilol, HCTZ, and lisinopril actively lower blood pressure.

Medications That Can RAISE Blood Pressure

Duloxetine (SNRI Antidepressant)

• SNRIs increase blood pressure by approximately 2/1 mm Hg through norepinephrine reuptake inhibition 1
• This effect is consistent across patients and represents a direct pharmacologic mechanism 1

Albuterol (Beta-2 Agonist)

• Should be used with caution in patients with hypertension due to sympathomimetic effects 2
• Large doses can aggravate cardiovascular conditions including hypertension 2
• The FDA label specifically warns about use in patients with "cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias and hypertension" 2

Quetiapine (Atypical Antipsychotic)

• Causes significant blood pressure increases in children and adolescents: 15.2% experienced systolic BP increases ≥20 mmHg versus 5.5% on placebo 3
• Diastolic BP increases ≥10 mmHg occurred in 40.6% on quetiapine versus 24.5% on placebo 3
• Blood pressure monitoring is required at baseline and periodically during treatment 3

Upadacitinib (JAK Inhibitor)

• JAK inhibitors and other kinase inhibitors are listed as medications that can increase blood pressure 1

Medications That LOWER Blood Pressure

Carvedilol (Beta-Blocker with Alpha-Blocking)

• Carvedilol is an antihypertensive agent used at doses of 12.5-50 mg twice daily 1
• Preferred in patients with heart failure with reduced ejection fraction 1

HCTZ (Thiazide Diuretic)

• HCTZ is a first-line antihypertensive medication recommended in combination therapy 4
• Provides significant blood pressure reductions when combined with other agents 4

Lisinopril (ACE Inhibitor)

• ACE inhibitors are first-line antihypertensive agents 1
• Preferred in patients with diabetes, chronic kidney disease, and heart failure 1

Medications with NEUTRAL or MINIMAL Effects

Aspirin (ASA)

• Low-dose aspirin does NOT interfere with blood pressure control 5
• The HOT study demonstrated that 75 mg daily aspirin produced "clinically irrelevant differences" in BP compared to placebo 5
• NSAIDs can increase BP by 3-6 mm Hg, but aspirin specifically does not cause this effect 1, 6

Vitamin D

• Not identified in guidelines as a blood pressure-raising agent 1

Farxiga (Dapagliflozin/SGLT2 Inhibitor)

• Not listed as a hypertension-inducing medication in major guidelines 1

Famotidine (H2 Blocker)

• Not identified as affecting blood pressure 1

Xyzal (Levocetirizine/Antihistamine)

• Not listed as a blood pressure-raising agent 1

Methocarbamol (Muscle Relaxant)

• Not identified in guidelines as affecting blood pressure 1

Singulair/Montelukast (Leukotriene Inhibitor)

• Not listed as a hypertension-inducing medication 1

Protonix (Pantoprazole/PPI)

• Not identified as affecting blood pressure 1

Lyrica (Pregabalin)

• Not listed in major guidelines as a blood pressure-raising agent 1

Buspar (Buspirone)

• Not identified as affecting blood pressure 1

Vortioxetine (Antidepressant)

• Not specifically listed, though it is an SSRI-type agent, and SSRIs do not increase blood pressure unlike SNRIs 1

Bimzelx (Bimekizumab/IL-17 Inhibitor)

• Biologic agents for inflammatory conditions are not listed as blood pressure-raising medications 1

Clinical Management Recommendations

Screen all hypertensive patients for medications that may raise blood pressure or interfere with antihypertensive therapy 1, 6

When duloxetine or quetiapine are necessary despite hypertension:

• Optimize antihypertensive regimen to compensate for the BP-raising effects 1
• Consider preferential use of RAS inhibitors (ACE inhibitors/ARBs) and calcium channel blockers in patients on antidepressants 1
• Monitor BP closely, especially in the first weeks of treatment 6

For albuterol use in hypertensive patients:

• Use the lowest effective dose and frequency 2
• Monitor cardiovascular status during treatment 2