Hypertension - medication related

Alternative names
Drug-induced hypertension

Definition
Hypertension (high blood pressure) can be caused by using a chemical substance, drug, or medication. It can also be caused by stopping a drug or medication. See also high blood pressure.

Causes, incidence, and risk factors

Blood pressure is determined by the amount of blood that is pumped by the heart, the pumping power of the heart, the condition of the heart valves, and the size and condition of the arteries. Many other factors can also affect blood pressure, including:

     
  • The volume of water in the body  
  • Foods eaten, weight, and other body-related variables  
  • Condition of the kidneys, nervous system, or blood vessels  
  • Levels of various hormones in the body

There are several types of high blood pressure. Essential hypertension has no identifiable cause. Secondary hypertension occurs because of another disorder. Drug-induced hypertension is a form of secondary hypertension caused by a response to medication.

Drugs that can cause hypertension include:

     
  • Alcohol, amphetamines, ecstasy (MDMA and derivatives), and cocaine  
  • Corticosteroids  
  • Estrogens (including birth control pills) and other hormones  
  • Migraine medications  
  • Cyclosporine  
  • Erythropoietin (used to correct anemia related to chronic diseases - such as kidney failure, cancer, and HIV)  
  • Nasal decongestants  
  • Many over-the-counter medications such as cough/cold medications and medications for asthma - particularly when the cough/cold medicine is taken with certain antidepressants like tranylcypromine or tricyclics  
  • High blood pressure medications (such as clonidine) when a person stops taking them - particularly if the medication is not tapered off (called rebound hypertension)

Symptoms

Headache is an occasional symptom. If the hypertension is severe, the following symptoms can occur:

     
  • Tiredness  
  • Confusion  
  • Vision changes  
  • Nausea and vomiting  
  • Anxiety  
  • Excessive perspiration  
  • Pale skin or redness  
  • Muscle tremors  
  • Chest pain

Note: Hypertension usually shows no symptoms.

Signs and tests

The health care provider will ask questions regarding the use of drugs which are known to affect blood pressure measurement.

Blood pressure measurements, repeated over time, are used to confirm the diagnosis. Blood pressure that is consistently elevated is considered hypertension.

Two factors determine blood pressure measurements. Systolic blood pressure is the “top” number and is a measurement of the pressure in the blood vessels when the heart beats. Diastolic blood pressure is the “bottom” number which reflects the pressure in blood vessels when the heart is at rest. A consistent rate of more than 140 mm Hg systolic and more than 90 mm Hg diastolic is considered high blood pressure.

Tests to determine the cause of the problem may include blood tests to determine the levels of suspect medications.

Treatment

The goal of treatment is to reduce your blood pressure, which will lower the risk of complications. The goal is blood pressure at least below 140/90 and below 130/80 if you have diabetes or kidney disease.

Whenever possible, the substance that caused your hypertension is discontinued. Adjustments may be made in medical therapy if current medications are causing hypertension and discontinuation of these drugs is not advisable.

MEDICATIONS that may be used to modify blood pressure include:

     
  • Diuretics  
  • Potassium replacements  
  • Beta blockers  
  • Calcium channel blockers  
  • Angiotensin-converting enzyme (ACE) inhibitors  
  • Angiotensin receptor blockers (ARB)  
  • Hydarlazine, doxazosin, and prazosin

Have your blood pressure checked at regular intervals (as recommended by your health care provider) to monitor its condition and response to treatment.

Lifestyle changes may be recommended, including such things as weight loss, exercise, avoidance of excess alcohol intake, and dietary adjustments.

Expectations (prognosis)
Drug-induced hypertension is usually controllable with treatment, which may require periodic adjustment.

Complications
Complications of untreated hypertension can include:

     
  • Heart attacks  
  • Congestive heart failure  
  • Other heart damage  
  • Blood vessel damage  
  • Kidney damage  
  • Stroke  
  • Loss of vision

Calling your health care provider

If you have high blood pressure, you will have regularly scheduled appointments with your doctor.

In between appointments, if you have any of the following symptoms call your health care provider right away:

     
  • Sever headache  
  • Excessive tiredness  
  • Confusion  
  • Visual changes  
  • Nausea and vomiting  
  • Chest pain  
  • Shortness of breath  
  • Significant sweating

Prevention

Use caution when ingesting any substance. If you are unsure of the likely effects and of interactions with other medications that you are already taking, consult your health care provider or pharmacist before using the substance or medication.

In people with hypertension, modification of sodium intake may be recommended. Products containing sodium (e.g., salt, MSG, and baking soda) often have little effect in people without hypertension, but may have a profound effect in those with hypertension.

If your doctor suspects drug-induced hypertension, it is important to discuss all drug use - including alcohol and other recreational drugs - so that the condition can be properly diagnosed.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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