From the Guidelines
Yes, ketamine infusion can cause hypertension.
Mechanism and Effects
Ketamine produces a dose-dependent increase in heart rate, blood pressure, and cardiac output, mediated through stimulation of the sympathetic nervous system 1. This increase in blood pressure is a significant consideration, particularly in patients with pre-existing hypertension, ischemic heart disease, or cerebrovascular disease, as its use could potentially be dangerous in these populations 1.
Clinical Considerations
The use of ketamine, especially in adults, should be approached with caution due to the potential for emergence reactions, which can include floating sensations, vivid dreams, hallucinations, and delirium, occurring in 10%–30% of adults 1. However, combining ketamine with midazolam has been shown to minimize these reactions 1.
Key Points
- Ketamine can increase blood pressure.
- It should be used cautiously in patients with hypertension or cardiovascular diseases.
- Combining ketamine with midazolam can reduce emergence reactions.
From the FDA Drug Label
Ketamine hydrochloride is contraindicated in patients for whom a significant elevation of blood pressure would constitute a serious hazard [see Warnings and Precautions (5. 1)]. Transient increases in blood pressure, heart rate, and cardiac index are frequently observed following administration of ketamine hydrochloride.
Ketamine infusion can cause hypertension. This is a known effect of the drug, and it is listed as a contraindication for patients who would be at risk from a significant elevation in blood pressure 2.
From the Research
Ketamine Infusion and Hypertension
- Ketamine infusion can cause transient increases in blood pressure, with the largest mean systolic/diastolic blood pressure increases being 7.4/6.0 mmHg 3.
- The maximum blood pressure and pulse values are typically observed at 30-40 min during infusions, with blood pressure and pulse elevations being transient and not causing serious cardiovascular events 3.
- Patients who are older (age ≥ 50 years), hypertensive, and receiving infusions while exhibiting dissociative symptoms may show greater maximal changes in systolic and diastolic blood pressure than patients who are younger (age < 50 years), normotensive, and without dissociative symptoms 3.
- Ketamine dosage is positively correlated with changes in systolic and diastolic blood pressure, with higher dosages leading to greater increases in blood pressure 3.
- In hypotensive states, ketamine can raise systemic arterial blood pressure and improve hemodynamics, increasing both perfusion and systemic pressure 4.
- In patients with depression, subanesthetic ketamine infusions can cause small, well-tolerated, and clinically insignificant increases in blood pressure, with the largest increases observed at 30 min after infusion 5.
- In children with pulmonary hypertension, ketamine is associated with minimal, clinically insignificant hemodynamic changes, including a mean increase in mean pulmonary artery pressure of 2 mmHg 6.
- Ketamine can effectively decrease intracranial pressure and prevent untoward intracranial pressure elevations during potentially distressing interventions, without lowering blood pressure and cerebral perfusion pressure 7.