Hypertensive adults commonly use medications that increase blood pressure

Almost one in five adults with hypertension take medications that can increase blood pressure (BP)— something that may contribute to many people not achieving recommended BP targets. This is according to a study in JAMA. Here, researchers used data from the long-term National Health and Nutrition Examination Survey (NHANES) to determine the prevalence of use of medications that may raise BP and assessed their associations with BP control and antihypertensive use. While various medications are known to affect blood pressure control, there has been little attention paid to their actual use by people with hypertension. Read: Fewer people filling prescriptions for hypertension meds compared to pre-pandemic: Shoppers “Given national trends of increasing polypharmacy, use of medications that raise BP may contribute to poor BP control rates and also worsen polypharmacy,” the paper said. In other words, if medications being used by patients raise blood pressure, then patients may be given additional antihypertensive medications to lower it. “Clinicians caring for patients with hypertension should routinely screen for these medications and, when identified, consider deprescribing them,” said coauthor Dr. John Vitarello, an internal medicine resident at Beth Israel Deaconess Medical Center. Often there are alternative medications that are not associated with increases in BP that could be used. Or, for some medications, doses can be lowered. For the study, data for 27, 599 adults pooled from five recent survey cycles from the NHANES database were used. Subjects in the cohort had a mean age of 46.9 years and 50.9% were women. A total of 49.2% of the cohort had hypertension and 35.4% had uncontrolled hypertension. Both hypertension and uncontrolled hypertension were defined as an average systolic BP of 130 mm Hg or higher, average diastolic BP of 80 mm Hg or higher. Answering “yes” to the question, “Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?” was included too. The researchers determined the prevalence of medication use (those that may cause increases in BP) by drug class. They then estimated the association between the use of medications that could raise BP and uncontrolled hypertension, and then stratified this according to antihypertensive use. Whether those with hypertension and who were using BP-raising medications were treated with larger numbers of antihypertensives was also investigated. It was found that 14.9% of the NHANES respondents reported using medications that may cause elevated BP, including 18.5% who had hypertension. Significant numbers used more than one medication that could increase BP. Results showed that the use of BP-raising medications was associated with a greater likelihood of uncontrolled hypertension among respondents who were not taking antihypertensives. But this was not seen among patients who were also taking antihypertensives. Another finding was that people who used medications that could raise BP were more likely to be on a great number of antihypertensives. The most commonly reported classes of medications that may raise BP used in the study population were antidepressants (8.7%), followed by prescription nonsteroidal anti-inflammatory drugs (NSAIDs) (6.5%), steroids (1.9%), and estrogens (1.7%). In addition, not all medications that can raise BP were captured in the study, said Dr. Vitarello. Only medications taken by mouth were included. Also, NHANES only collected information on prescription medication, except for pseudoephedrine, meaning over-the-counter (OTC) medication use was not taken into account, he said. However, an OTC version of medications such as ibuprofen are “expected to have the same response as ibuprofen taken as a prescription. An important caveat is dosage. A higher dose may have a greater effect on blood pressure…. We speculate that people on prescription NSAIDs take them more chronically and at higher doses than those who buy and use them over the counter,” he told the Medical Post. NHANES does not collect information on dosage. When the problem happens, often there are alternative treatments which don’t have the adverse effect of raising BP. For example, acetaminophen can be used in place of NSAIDs. Or progestin-only or nonhormonal contraceptives in place of ethinyl estradiol–containing contraceptives could be used. Talking to a pharmacist can help, said Dr. Vitarello. For a list of medication classes known to be association with BP elevation, healthcare providers can turn to the 2017 American College of Cardiology and American Heart Association blood pressure guideline section “Drugs and Other Substances With Potential to Impair BP Control.” Generally, the results don’t come as a big surprise, said Aaron Tejani, PharmD, an educator at the University of British Columbia’s Therapeutics Initiative. He was not involved in the study. Considering the large numbers of people with hypertension, the 18.5% prevalence may be likely, but added that it would be interesting to see if other studies also show this. He noted that the issue of a medical problem arising from a medication which is then treated itself with another medication is known as a “prescribing cascade.” Practitioners aren’t always aware that a secondary medical problem was medication related. An example is prescribing a diuretic to treat edema which can be caused by gabapentin, he said. Physicians and pharmacists are already overburdened, so a solution to reducing prescribing cascades isn’t just about education. Better tools need to be developed to help practitioners, such as smart databases that could give alerts when associations between symptoms and medication effects are found, he said. But looking at new symptoms and reviewing medications and their possible effects can help.

Hypertensive adults commonly use medications that increase blood pressure

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