Does escitalopram (Lexapro) cause hypertension?

From the Guidelines

Escitalopram (Lexapro) does not cause hypertension.

Evidence Summary

• According to the 2020 international society of hypertension global hypertension practice guidelines 1, there is no increase in blood pressure with SSRI (selective serotonin reuptake inhibitors), which includes escitalopram.
• The guidelines do report increases in blood pressure with other types of antidepressants, such as SNRI (selective norepinephrine and serotonin reuptake inhibitors) with a 2/1 mm Hg increase, and tricyclic antidepressants with an increased odds ratio of 3.19 of hypertension.
• However, SSRIs, like escitalopram, are not associated with an increase in blood pressure.
• It's essential to note that individual responses to medications may vary, and serial assessment of blood pressure should be considered when prescribing any medication that may potentially affect blood pressure.

From the FDA Drug Label

The following have been reported with Escitalopram tablet overdosage: ... • Cardiovascular toxicity, which may be delayed, including ... Hypertension most commonly seen, but rarely can see hypotension alone or with co-ingestants including alcohol.

• Hypertension is mentioned as a possible effect of escitalopram overdose.
• The information provided is in the context of an overdose, not standard dosing.
• There is no direct information about the effect of escitalopram on blood pressure at standard doses.
• Based on the available information, no conclusion can be drawn about the risk of hypertension with standard use of escitalopram 2.

From the Research

Escitalopram and Hypertension

• The relationship between escitalopram (Lexapro) and hypertension is complex, with some studies suggesting a potential link between the two, while others indicate no significant effect on blood pressure.
• A study published in 2019 3 found that escitalopram decreased heart rate but did not significantly affect systolic or diastolic blood pressure in individuals with hypertension and depression.
• Another study from 2019 4 analyzed pharmacovigilance databases and found a significant association between the use of selective serotonin reuptake inhibitors (SSRIs), including escitalopram, and the development or worsening of hypertension.
• A case report from 2014 5 described a patient who developed sustained hypertension after abruptly discontinuing citalopram, a racemic SSRI that includes escitalopram as its active enantiomer.
• The clinical pharmacokinetics of escitalopram were studied in 2007 6, but this study did not investigate the drug's effects on blood pressure.
• A review of antidepressant drugs' effects on blood pressure, published in 2021 7, noted that SSRIs like escitalopram have limited effects on autonomic system activity and a lower impact on blood pressure, making them a relatively safe choice for patients with cardiovascular conditions.

Key Findings

• Escitalopram may decrease heart rate but does not significantly affect blood pressure in individuals with hypertension and depression 3.
• SSRIs, including escitalopram, may be associated with an increased risk of developing or worsening hypertension 4.
• Abrupt discontinuation of citalopram, which includes escitalopram as its active enantiomer, may lead to sustained hypertension in some cases 5.
• The clinical pharmacokinetics of escitalopram do not provide direct evidence for its effects on blood pressure 6.
• SSRIs like escitalopram are considered a relatively safe choice for patients with cardiovascular conditions due to their limited effects on autonomic system activity and blood pressure 7.