Common medications can raise blood pressure, study says

High blood pressure remains one of the leading causes of death and disability in the United States today. Nearly half of adults have high blood pressure and only a quarter of them keep their blood pressure under control, putting them at greater risk of heart attack, stroke, dementia, kidney disease and other illnesses.

Before the coronavirus pandemic, high blood pressure caused or contributed to more than 500,000 deaths a year in the US, according to the CDC. Those numbers have likely increased as blood pressure readings soared during the pandemic.

You may have thought for a long time that your blood pressure was within normal limits. But in 2017, based on better long-term data, experts reduced the numbers that constitute healthy blood pressure, resulting in a higher proportion of the population having this at-risk condition.

The former upper limit of “normal” blood pressure, which was believed to be 140 by 90 millimeters of mercury (14×9), was recognized as too high to prevent serious long-term health problems. The current upper limit of normal pressure is 130 over 80 (13×8), and a blood pressure consistently above 120 over 80 (12×8) is now considered problematic.

There are many reasons for the high rate of uncontrolled hypertension, the medical term for high blood pressure, in the US.

Excess weight and, for many, excessive salt consumption lead the list, followed by inconsistent use of prescription drugs and failure to adopt lifestyle habits that can reduce high blood pressure.

Now, a new study has highlighted another problem often unknown to patients and overlooked by doctors that can complicate hypertension treatment and swell the ranks of people with uncontrolled high blood pressure: the sheer number of medications and supplements they take, some of which can increase blood pressure and undermine the benefits of effective treatment.

The study involved 27,599 adults, 35.4% of whom had uncontrolled hypertension, who were part of the National Health and Nutrition Examination Surveys in the country.

The periodic surveys, which are known as NHANES and track the health of a representative sample of Americans, found that many people took medications and other substances that could increase normal blood pressure or limit the effectiveness of prescribed treatment to reduce high blood pressure.

Among adults in the survey, 17.5% whose hypertension was not adequately controlled were taking prescription drugs that can raise blood pressure, the researchers reported. And 18.5% of survey participants with hypertension that was effectively treated were also taking these drugs, suggesting that some of these people may not need blood pressure treatment.

The study was published online last year in JAMA Internal Medicine. Its lead author, Timothy S. Anderson, a primary care physician at Beth Israel Deaconess Medical Center in Boston, said he and his colleagues hoped to alert more clinicians and patients to the ways that drugs or other substances might contribute to increased blood pressure.

Increased awareness would be especially helpful before patients are given blood pressure lowering drugs or more potent drugs to increase the effectiveness of current treatment.

For some medical conditions unrelated to hypertension, changing medication can bring the patient’s high blood pressure back to normal.

For example, the study authors suggested that women taking an estrogen-containing oral contraceptive, which can increase blood pressure, might switch to a progestin-based or non-hormonal contraceptive. Likewise, those taking a nonsteroidal anti-inflammatory drug, or NSAID, to manage pain may use acetaminophen.

There is a long list of prescription drugs, as well as over-the-counter drugs and recreational substances and supplements, that can interfere with the effective treatment of hypertension.

In addition to estrogen-containing drugs and NSAIDs, the list includes widely used drugs such as antidepressants and oral steroids such as cortisone; substances such as nicotine, alcohol and cocaine; herbal supplements like licorice or ginseng; and, of course, salt. Caffeine can also raise short-term blood pressure in some people.

When doctors don’t ask patients what else they’re taking, using or consuming that could affect their blood pressure — or if patients don’t mention all the herbal and nonprescription medicines they take — patients can be prescribed an unnecessary or more potent blood pressure medication that can have uncomfortable side effects.

Dr. Anderson said doctors “were taught to ask patients initially about other drugs that can raise blood pressure, but patients aren’t necessarily screened for those drugs over time.”

He said it’s important for doctors to get good clinical histories, including what may have changed in patients’ lives since their blood pressure was under control.

“Perhaps there was a change in diet that caused a rapid rise in blood pressure,” Dr. Anderson said. “For example, some patients are very sensitive to salt,” he said. “Together with age and weight, it is the strongest predictor of high blood pressure over time.”

Switching to just one frequently consumed high-salt food, such as pizza, cured meats, or canned soup, may be enough to lower your risk of high blood pressure.

To complicate matters, people’s reactions to various substances, such as commonly prescribed SSRI antidepressants, are “very idiosyncratic,” he explained. “A specific SSRI can have a high impact on blood pressure in some patients, but not in others.”

For patients with hypertension who need to take a drug that can raise blood pressure, Dr. Anderson advises using a blood pressure monitor at home. A sudden rise in blood pressure after starting a new medication can help alert the doctor to the need to switch to an alternative medication, if one is available.

Even if you’ve had normal blood pressure for five decades or more, there’s a 90% chance of developing hypertension as you age, which makes it even more important to modify risks like dietary salt and excess weight while you’re still healthy.

Even a modest weight loss of 5 kg can reduce the risk of developing hypertension and lower blood pressure in overweight people who already have this condition.

Another common predictor is a sedentary lifestyle. Adopting the habit of regular physical activity can help people maintain normal blood pressure throughout their lives. Other effective measures to control hypertension include quitting smoking and limiting alcohol consumption.

“Even a modest reduction in smoking and drinking can have a positive impact on blood pressure,” said Dr. Anderson.

Before starting hypertension medication, show your doctor a list of all medications—prescription and nonprescription—you take and disclose any problematic substances, especially large amounts of dietary salt, that you use or ingest on a regular basis.

Translated by Luiz Roberto M. Gonçalves