Nearly 1 in 5 Americans With Hypertension Taking Meds That Raise Blood Pressure

(Reuters Health) – One overlooked obstacle to blood pressure control may be that almost 18% of Americans with hypertension, and 15% of U.S. adults overall, are taking medications that raise blood pressure, a new study suggests.

An analysis of data on a sample of more than 27,000 Americans reveals that the most common medications that have the side effect of bumping up blood pressure include antidepressants, prescription NSAIDs, steroids and estrogens, according to the report published in JAMA Internal Medicine.

“Reducing the use of medications that may raise blood pressure has the potential to improve population blood pressure control rates and reduce polypharmacy,” said study coauthor Dr. Timothy Anderson, a clinical investigator in the division of general medicine at Beth Israel Deaconess Medical Center and an assistant professor of medicine at the Harvard Medical School in Boston.

“Clinicians caring for patients with hypertension should routinely screen for these medications and when identified, consider deprescribing them, seek therapeutic alternatives, or minimizing the dose and duration of use when alternatives are not available,” Dr. Anderson said in an email.

What about cases where the alternatives are not as effective?

“There are certainly scenarios where the benefit of blood pressure raising medications may outweigh the risk of blood pressure elevation,” Dr. Anderson said. “In these instances, the smallest effective dose for the shortest duration can mitigate blood pressure raising side effects. The goal of our article is to foster dialogue between clinicians and patients with high blood pressure about the risks and benefits of these medications, not to suggest any specific medications are not appropriate.”

To take a closer look at medications that might raise blood pressure as a side effect, Dr. Anderson and his colleagues analyzed data from the National Health and Nutrition Examination Survey (NHANES).

They focused on 27,599 adults who were not pregnant during five survey cycles (2009-2018).

Information on prescription medication use came from home interviews. Hypertension was defined as an average systolic blood pressure of 130 mm Hg or higher, an average diastolic blood pressure 80 mm Hg or higher, or a “yes” answer when asked if the participant had ever been told they had hypertension or high blood pressure.

Among adults included in the study, 49.2% had hypertension and 35.4% had uncontrolled hypertension. The mean age was 46.9, and 59.9% were women, 11.3% were Black, 14.8% were Hispanic, and 63.3% were non-Hispanic white.

Overall, 14.9% of participants reported using medications that may raise blood pressure, including 18.5% of those with hypertension. The most commonly reported classes of blood pressure-raising medications were antidepressants (8.7%), prescription NSAIDs (6.5%), steroids (1.9%) and estrogens (1.7%).

Dr. Anderson and his colleagues found that the use of blood pressure raising medications was associated with greater odds of uncontrolled hypertension among adults not currently taking antihypertensives (odds ratio 1.24), but not among patients concurrently taking antihypertensives.

The researchers suggested examples of medications that might be substituted for those that raise blood pressure, including acetaminophen for NSAIDs, and progestin-only or non-hormonal contraceptives in place of ethinyl estradiol-containing contraceptives.

“This is an interesting, but not a paradigm-changing, finding,” said Dr. Carlos Santos-Gallego, a cardiologist and an instructor at the Icahn School of Medicine at Mount Sinai in New York City, who wasn’t involved in the study.

Still, Dr. Santos-Gallego said, “it’s important and confirms we have to try to avoid medications that increase blood pressure when possible. You have to individualize the risk and benefits in each case. If these medications are really needed, then you have to increase the intensity of blood pressure lowering pharmacological and non-pharmacological methods.”

SOURCE: JAMA Internal Medicine, online November 22, 2021.

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