Researchers find some medicines could raise blood pressure

Many People with High Blood Pressure are Taking a Medicine that Could Actually Raise It

Boston – Nearly 1 in 5 adults with high blood pressure, a leading risk factor for heart disease and stroke, also take a medicine that could be elevating their blood pressure, according to new research conducted by physician-researchers at Beth Israel Deaconess Medical Center (BIDMC) and presented at the American College of Cardiology's 70th Annual Scientific Session. The findings underscore the need for patients to routinely review all of the medications they take with their care team, including those available over the counter, to make sure none could be interfering with blood pressure lowering efforts.

Based on the study findings, the three most common classes of medications were antidepressants; nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen; and oral steroids used to treat conditions such as gout, lupus, rheumatoid arthritis or after an organ transplant. These medications were reported by 9 percent, 7 percent and 2 percent of participants, respectively. Other medications associated with blood pressure elevation were also reported, including antipsychotics, certain oral contraceptives and popular decongestants.

"It is important to consider the balance of risks and benefits for all medications, particularly in older adults who have the greatest burden of high blood pressure and of polypharmacy" said Timothy Anderson, MD, MAS, the study's corresponding author and a clinician-investigator in the Division of General Medicine and Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at BIDMC. "Our findings suggest that in some cases rather than treating high blood pressure with more medications, there may be opportunity to lower blood pressure by deprescribing or substituting safer medications."

Researchers said these findings raise concerns, especially as nearly half of Americans diagnosed with high blood pressure do not have it sufficiently controlled. John Vitarello, MD, an internal medicine resident at BIDMC and the study's lead author, explained the goal blood pressure for hypertension patients is less than 130 mmHg over 80 mmHg, based on the 2017 American College of Cardiology/American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

"These are commonly taken medications—both over-the-counter and prescribed medications—that may have the unintended side effect of raising blood pressure and could have adverse effects on our heart health," said Vitarello. "We know that high blood pressure can lead to cardiovascular disease, stroke and death and even small increases in blood pressure can have meaningful impacts on cardiovascular disease. Based on our findings, physicians need to be more aware of the use of multiple medications by a single patient in older adults who also have the highest burden of high blood pressure."

The study examined data from more than 27,000 participants in the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2018. Of these, about half (49 percent) had hypertension (average age 55 years, 48 percent female), which was defined in the study as having a blood pressure reading of ≥130 mmHg (systolic, the top number) or ≥80 mmHg (diastolic, the bottom number) or ever having been told they have high blood pressure. Researchers identified medications associated with blood pressure elevation based on those listed in the ACC/AHA guideline and examined use of these medications by adults with hypertension above and below recommended blood pressure goals.

Among participants with high blood pressure, 19 percent reported using one or more blood pressure raising medications and 4 percent reported using multiple. Nearly one-quarter (24 percent ) of women with high blood pressure reported using a blood pressure raising medication compared with 14 percent of men. Older adults were more likely to be using blood pressure raising medications than younger adults (19 percent of participants over age 65 vs. 18 percent of participants under age 65).

Vitarello said the findings suggest that, in some cases, there may be other classes of medications to treat the same condition that have less impact on blood pressure. Nevertheless, there are some patients who may not have another medication option, so it's advisable to keep a close eye on their blood pressure and talk with their care team before stopping or starting medications.

Additionally, the study authors estimate that if half of U.S. adults with hypertension who are taking blood pressure raising medications were to discontinue one of these medications, 560,000 to 2.2 million patients could be able to achieve their blood pressure goals without additional medications. But Vitarello said this analysis is only preliminary and individual responses to stopping blood pressure medications are likely to vary, thus the real-world benefit and tradeoffs of stopping these medications need to be further studied.

The study is limited in that it relies on participants' self-report of having high blood pressure and an accurate accounting of all the medications they take.

Vitarello will present the study, "Use and Estimated Impacts of Medications that Raise Blood Pressure Among U.S. Adults with Hypertension: National Cross-Sectional Study," on Sunday, May 16, at 12:30 p.m. ET / 16:30 UTC.

This work was supported by grants to Dr. Anderson from the National Institute on Aging (5R03AG064373) and the American College of Cardiology (Bellows Geriatric Cardiology Career Development Award).

The authors declare no competing interests.

Editor's note: This release was adapted from a press release issued by the American College of Cardiology.