Will Ativan (lorazepam) lower blood pressure in a patient with primary hypertension?

From the Guidelines

Ativan (lorazepam) is not recommended for treating primary hypertension, and instead, medications such as ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, or beta-blockers should be used to manage chronic high blood pressure. While Ativan may temporarily lower blood pressure in some patients due to its anxiety-reducing and sedative effects, it is not an appropriate medication for managing chronic high blood pressure. Primary hypertension should be treated with medications specifically designed for this purpose, which target the physiological mechanisms that regulate blood pressure, as recommended by the 2017 American College of Cardiology/American Heart Association hypertension guideline 1.

Key Points to Consider

• The guideline recommends initiating therapy with thiazide diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers for adults without a compelling indication for use of a specific drug 1.
• Thiazide diuretics (especially chlorthalidone) and calcium-channel blockers are the preferred options for first-line therapy in most U.S. adults because of their efficacy 1.
• Using benzodiazepines like Ativan for blood pressure control could lead to dependence and withdrawal issues without addressing the underlying cause of hypertension.
• Patients with primary hypertension should consult their healthcare provider for appropriate antihypertensive medications and lifestyle modifications, including reduced sodium intake, regular exercise, weight management, limited alcohol consumption, and smoking cessation.

Management of Primary Hypertension

The management of primary hypertension should focus on reducing blood pressure to prevent cardiovascular complications, and this can be achieved through a combination of lifestyle modifications and antihypertensive medications. The choice of antihypertensive drug therapy should be based on the patient's individual characteristics, such as the presence of comorbidities, and the potential benefits and risks of each medication. Regular monitoring of blood pressure and adjustment of the treatment regimen as needed are crucial to achieving optimal blood pressure control 1.

From the FDA Drug Label

Small decreases in blood pressure and hypotension may occur but are usually not clinically significant, probably being related to the relief of anxiety produced by lorazepam.

Lorazepam (Ativan) may bring a blood pressure reading down in patients with primary hypertension, but the effect is usually not clinically significant. The decrease in blood pressure is likely related to the relief of anxiety produced by the medication 2.

• Key points:
  • Small decreases in blood pressure may occur
  • Effect is usually not clinically significant
  • Related to relief of anxiety produced by lorazepam

From the Research

Effect of Ativan on Blood Pressure in Primary Hypertension

• Ativan, a benzodiazepine, is primarily used for its anxiolytic properties, but its effect on blood pressure in patients with primary hypertension is of interest.
• A study published in 2023 3 found that benzodiazepines, including Ativan, may have a hypotensive effect in the short term, potentially due to their ability to potentiate the inhibitory effect of gamma-amino butyric acid (GABA) in the central nervous system and their vasodilatory properties.
• The meta-analysis included in this study found that benzodiazepines were comparable to standard drugs in reducing systolic and diastolic blood pressure in patients with hypertension, although the mean difference in systolic blood pressure with benzodiazepines and placebo was not statistically significant.
• Another study from 1978 4 investigated the effect of lorazepam, a benzodiazepine similar to Ativan, on hypertension-associated anxiety and found that it significantly relieved symptoms of anxiety, but did not specifically address its effect on blood pressure.

Comparison with Other Antihypertensive Drugs

• Studies have established the efficacy of various antihypertensive drug classes, including thiazides, beta-blockers, ACE inhibitors, and calcium channel blockers, in lowering blood pressure and reducing the risk of cardiovascular disease 5, 6, 7.
• A review published in 2018 7 compared the effects of different first-line antihypertensive drug classes and found that low-dose thiazides, ACE inhibitors, and calcium channel blockers were effective in reducing blood pressure and cardiovascular risk, while beta-blockers were less effective.
• However, the effect of Ativan on blood pressure in primary hypertension is not directly compared to these drug classes in the available studies.

Limitations and Future Research

• The current evidence on the effect of Ativan on blood pressure in primary hypertension is limited, and more clinical trials and mechanistic research are required to ascertain its long-term benefits and potential as an add-on antihypertensive therapy 3.
• Further studies should investigate the efficacy and safety of Ativan in patients with primary hypertension, as well as its potential interactions with other antihypertensive drugs.