Sertraline and Blood Pressure
Sertraline does not increase blood pressure and may actually help stabilize or increase blood pressure in specific clinical contexts, particularly in patients with intradialytic hypotension or autonomic dysfunction. 1
Evidence from Hypertension Guidelines
The most authoritative hypertension guidelines do not list sertraline or SSRIs as medications that increase blood pressure:
The 2017 ACC/AHA hypertension guidelines specifically mention that SSRIs (selective serotonin reuptake inhibitors) are NOT included in the list of medications that raise blood pressure, unlike SNRIs (serotonin-norepinephrine reuptake inhibitors) and tricyclic antidepressants which ARE listed as problematic. 1
The International Society of Hypertension 2020 guidelines identify antidepressants that increase blood pressure as primarily SNRIs and tricyclics, but do not include SSRIs like sertraline in their list of blood pressure-elevating medications. 2, 3
Weight and Metabolic Effects
From a practical standpoint regarding cardiovascular risk:
Sertraline is associated with weight loss in short-term use and weight neutrality with long-term use, which distinguishes it favorably from other antidepressants like paroxetine that cause weight gain. 1
This weight-neutral profile is clinically relevant because weight gain itself can contribute to blood pressure elevation. 1
Paradoxical Blood Pressure Benefits
Interestingly, sertraline has demonstrated blood pressure-raising effects in specific hypotensive conditions:
In patients with intradialytic hypotension, sertraline (50-100 mg daily) significantly increased nadir mean arterial pressure from 55±4 mmHg to 68±5 mmHg and reduced hypotensive episodes by 43%. 4, 5
In patients with paroxysmal hypertension (pseudopheochromocytoma), sertraline 50 mg daily reduced symptoms in 75% of patients and actually decreased office blood pressure by 12.8/7.4 mmHg, suggesting it helps normalize autonomic dysfunction rather than causing hypertension. 6
The mechanism appears to involve attenuation of paradoxical sympathetic withdrawal that occurs in autonomic dysfunction, neurocardiogenic syncope, and dialysis-related hypotension. 1, 4, 7
Clinical Bottom Line
For patients with normal blood pressure or hypertension, sertraline does not require blood pressure monitoring beyond routine care and is not contraindicated. 1 This is in stark contrast to SNRIs (like venlafaxine, duloxetine) and tricyclic antidepressants, which do require blood pressure monitoring and may necessitate adjustment of antihypertensive therapy. 1
The only scenario where sertraline affects blood pressure clinically is in patients with autonomic dysfunction causing hypotension, where it may actually be therapeutic by increasing blood pressure toward normal. 1, 4, 5, 7