Do Eliquis (apixaban) 5 mg twice daily, bupropion 150 mg daily, rosuvastatin 10 mg daily, eplerenone 25 mg daily, and clonazepam 0.5 mg as needed for anxiety lower diastolic blood pressure?

Medications That Lower Diastolic Blood Pressure

Eplerenone 25 mg is the only medication in your regimen that directly lowers diastolic blood pressure, as it is a mineralocorticoid receptor antagonist specifically prescribed for hypertension. 1

Blood Pressure Effects of Each Medication

Eplerenone 25 mg – Lowers Diastolic BP

• Eplerenone is an aldosterone antagonist used as an antihypertensive agent that reduces both systolic and diastolic blood pressure through volume reduction and blockade of mineralocorticoid receptors. 1
• When used as part of triple therapy (ARB/ACE inhibitor + calcium channel blocker + mineralocorticoid antagonist), eplerenone provides additional blood pressure reductions of approximately 10-12 mmHg diastolic. 1
• As a fourth-line agent for resistant hypertension, spironolactone (a related mineralocorticoid antagonist) demonstrates diastolic reductions, and eplerenone works through the same mechanism with fewer side effects. 1, 2

Eliquis (Apixaban) 5 mg Twice Daily – No Effect on BP

• Apixaban is a direct factor Xa inhibitor anticoagulant with no known effect on blood pressure regulation. 3
• Drug interactions with rosuvastatin do not alter blood pressure effects, though they may affect apixaban concentrations. 3

Bupropion 150 mg – May Raise BP

• Bupropion, a dopamine-norepinephrine reuptake inhibitor, can lead to blood pressure increases, particularly at higher doses, through sympathetic nervous system activation. 4
• In adults treated for ADHD, bupropion was associated with a statistically significant increase in systolic blood pressure of +5.9 mmHg (p<0.05), though diastolic effects were not specifically elevated in that study. 5
• Bupropion may also cause orthostatic hypotension in patients with cardiovascular disease, but this does not represent a sustained diastolic reduction. 4

Rosuvastatin 10 mg – No Direct Effect on BP

• Statins, including rosuvastatin, are lipid-lowering agents without direct antihypertensive properties. 3
• Rosuvastatin does not interact with P-glycoprotein or CYP3A4 pathways in ways that would affect blood pressure. 3

Clonazepam 0.5 mg As Needed – May Lower BP Acutely

• Benzodiazepines, including clonazepam, reduce blood pressure in the short term through anxiolytic effects and potentiation of GABA-mediated inhibition in the central nervous system. 6
• In a meta-analysis of seven studies, benzodiazepines demonstrated clinically meaningful reductions in both systolic and diastolic blood pressure compared to placebo, though the effect was modest. 6
• However, this effect is acute and related to anxiety reduction; as-needed dosing of clonazepam 0.5 mg is unlikely to provide sustained diastolic blood pressure lowering. 6
• Clonazepam's hypotensive effect is most relevant during periods of active use, not as a chronic antihypertensive strategy. 2, 6

Clinical Implications

• If you are taking eplerenone specifically for hypertension, it is working to lower your diastolic blood pressure. 1
• Bupropion may counteract blood pressure control by raising systolic pressure, though the effect is typically modest. 5, 4
• Clonazepam provides only transient blood pressure reduction during episodes of anxiety, not sustained diastolic control. 6
• If your diastolic blood pressure remains elevated despite eplerenone, your physician may need to optimize doses of other antihypertensive agents or add additional classes such as ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. 1