Researchers document use of medications that may raise blood pressure as an adverse effect

BOSTON – Nearly half of all adults in the United States have hypertension, also known as high blood pressure. One overlooked risk factor for hypertension is the use of medications that may raise blood pressure, including non-steroidal anti-inflammatory drugs such as ibuprofen, certain antidepressants and birth control pills.

In a research letter published in JAMA Internal Medicine, researchers at Beth Israel Deaconess Medical Center (BIDMC) report the findings from a cross-sectional study characterizing the prevalent use of prescription medications that may raise blood pressure. The team’s findings suggest that many people take medications that may raise blood pressure that contribute to poor control of it, and also worsen polypharmacy – the use of five or more medications by a single patient.

“Many medications known to raise blood pressure have therapeutic alternatives without this adverse effect – for example, acetaminophen in place of anti-inflammatories and progestin-only or non-hormonal contraceptives in place of ethinyl estradiol-containing contraceptives,” said lead author John Vitarello, MD, an internal medicine resident at BIDMC. “Our findings indicate an important opportunity to improve blood pressure control by optimizing medication regimens, an approach that has the potential to also reduce polypharmacy and medication regimen complexity.”

Vitarello and colleagues analyzed data about prescription medication use from the long-running National Health and Nutrition Examination Survey (NHANES). The de-identified data were taken from NHANES surveys from 2009-2018 and included over 27,000 participants who were 18 years or older.

In this nationally representative survey study, 18 percent of US adults with hypertension reported taking medications that may cause elevated blood pressure. The use of such medications was linked to increased odds of uncontrolled hypertension – or systolic blood pressure of 140 and higher – among those not taking blood pressure medication, and was also linked to greater use of blood pressure medications among those with both controlled and uncontrolled blood pressure.

“Clinicians caring for patients with hypertension should routinely screen for medications that may cause elevated blood pressure and consider deprescribing, replacing them with safer therapeutic alternatives, and minimizing the dose and duration of use when alternatives are not available,” said senior author Timothy Anderson, MD, MAS, a physician-researcher in the Division of General Medicine at BIDMC and an assistant professor of medicine at Harvard Medical School.

Co-authors included Clara J. Fitzgerald, MPH, Jennifer L. Cluett, MD, and Stephen Juraschek, MD, PhD of BIDMC.

This work was supported by grants from the National Institute on Aging (L30AG060493 and R03AG 064373), National Heart, Lung and Blood Institute (K23HL135273), American College of Cardiology and Boston Claude D. Pepper Older Americans Independence Center.

Anderson reported receiving honoraria from Alosa Health, a nonprofit educational organization with no relationship to any drug or device manufacturers, related to deprescribing education, outside the submitted work. No other disclosures were reported.