Does Lexapro Raise Blood Pressure?
Lexapro (escitalopram) does not typically raise blood pressure and may actually lower it, particularly in patients with both hypertension and depression. 1, 2
Evidence from FDA Drug Labeling
The FDA label for escitalopram indicates that hypertension is most commonly seen in overdose situations, not with therapeutic dosing 3. This is an important distinction—blood pressure elevation is associated with toxicity, not normal clinical use.
Clinical Research Findings
Blood Pressure Lowering Effects
The most recent and highest quality evidence demonstrates beneficial effects on blood pressure:
A 2024 randomized clinical trial showed significant blood pressure reductions when citalopram (escitalopram's parent compound) was added to standard antihypertensive therapy in patients with depression and hypertension 2
- After 2 months: systolic BP decreased by 9.3 mmHg (133.8 vs 124.5 mmHg, p=0.009) and diastolic BP by 7.0 mmHg (80.7 vs 73.7 mmHg, p=0.002) compared to antihypertensive therapy alone 2
A 2019 study in hypertensive patients with depression found escitalopram decreased heart rate (66.79 vs 74.10 bpm, p=0.044) but had no significant effect on systolic or diastolic blood pressure 1
A 2004 study showed enhanced blood pressure control when citalopram was added to enalapril therapy, with greater reductions in 24-hour systolic BP time indexes compared to antihypertensive therapy alone 4
Cardiovascular Effects in Context
- In an 8-month comparative trial with duloxetine, escitalopram showed minimal cardiovascular effects: mean systolic BP increased by only 0.31 mmHg and diastolic BP decreased by 0.24 mmHg 5
- The incidence of sustained hypertension was only 1.1% with escitalopram over 8 months 5
Important Clinical Caveats
Rare Bradycardia and Hypotension
- One case report documented symptomatic bradycardia and mild hypotension (systolic BP 105 mmHg) with citalopram 20 mg daily, which resolved within 48 hours of discontinuation 6
- This represents a rare idiosyncratic reaction rather than a typical effect 6
Not Listed as Hypertensive Agent
- Major hypertension guidelines do not include SSRIs like escitalopram in their comprehensive lists of medications that raise blood pressure 7, 8
- Guidelines specifically list antidepressants that DO raise blood pressure: SNRIs (2/1 mmHg increase) and tricyclic antidepressants (odds ratio 3.19 for hypertension) 7
- SSRIs are explicitly noted as causing no increases in blood pressure in the International Society of Hypertension guidelines 7
Clinical Recommendations
For patients with hypertension requiring antidepressant therapy, escitalopram is a reasonable choice that will not interfere with blood pressure control and may provide modest benefit 1, 2.
Monitor blood pressure and heart rate during the first week of therapy, particularly in elderly patients or those with pre-existing cardiac disease, to detect rare idiosyncratic reactions 6.
Do not discontinue or avoid escitalopram due to concerns about blood pressure elevation—the evidence supports safety and potential benefit in hypertensive patients 2, 4.