Zoloft Does Not Lower Blood Pressure in Most Patients
Sertraline (Zoloft) does not lower blood pressure and is not classified as a blood pressure-elevating medication, making it safe for use in patients with hypertension without requiring additional blood pressure monitoring beyond routine care. 1
Evidence from Hypertension Guidelines
The most authoritative hypertension guidelines clearly distinguish sertraline from other antidepressants that affect blood pressure:
SSRIs like sertraline are NOT included in lists of medications that raise blood pressure, unlike SNRIs (which increase BP by 2/1 mmHg) and tricyclic antidepressants (which increase odds of hypertension by 3.19-fold). 2, 1
The International Society of Hypertension specifically identifies SNRIs and tricyclics as blood pressure-elevating antidepressants but does not include SSRIs in this category. 2, 1
For patients with normal blood pressure or hypertension, sertraline does not require blood pressure monitoring beyond routine care and is not contraindicated. 1
Metabolic Advantages
Sertraline has a favorable metabolic profile that indirectly supports cardiovascular health:
- Weight-neutral profile: Sertraline causes weight loss in short-term use and weight neutrality with long-term use, which is clinically relevant since weight gain itself can contribute to blood pressure elevation. 1
Special Populations Where Sertraline May Actually Raise Blood Pressure
There are specific clinical scenarios where sertraline has demonstrated blood pressure increases rather than decreases:
Paroxysmal Hypertension (Pseudopheochromocytoma)
- In patients with paroxysmal hypertension, sertraline 50-100 mg daily increased mean office blood pressure by 12.8/7.4 mmHg (P<0.001), while simultaneously reducing paroxysmal symptoms in 75% of patients. 3
Dialysis-Related Hypotension
In hemodialysis patients with intradialytic hypotension, sertraline increased nadir blood pressure by 4.9/3.8 mmHg and postdialysis blood pressure by 8.7/6.0 mmHg, reducing hypotensive episodes by 43%. 4, 5
This effect appears mediated by attenuation of paradoxical sympathetic withdrawal that occurs in autonomic dysfunction, suggesting sertraline helps normalize autonomic function rather than causing primary hypertension. 1, 4
The blood pressure-raising effect was only significant in non-diabetic dialysis patients. 5
Clinical Bottom Line
Sertraline neither lowers nor raises blood pressure in the general population with hypertension or normal blood pressure. 1, 6 In a randomized trial of 101 psychiatric patients with hypertension, 3 months of SSRI treatment (including sertraline) showed no significant effect on blood pressure levels compared to non-users. 6
The only exceptions are specialized populations with autonomic dysfunction (dialysis patients, paroxysmal hypertension), where sertraline may paradoxically increase blood pressure by normalizing dysautonomia. 1, 3, 4, 5