Drug-induced hypertension

Definition

Drug-induced hypertension is high blood pressure caused by using a chemical substance, drug, or medication.

See also: High blood pressure

Alternative Names

Hypertension - medication related

Causes, incidence, and risk factors

Blood pressure is determined by the:

• Amount of blood the heart pumps
• Condition of the heart valves
• Pumping power of the heart
• Size and condition of the arteries

Many other factors can also affect blood pressure, including:

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

There are several types of high blood pressure.

• Essential hypertension has no cause that can be found.
• 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
• Cyclosporine
• Erythropoietin
• Estrogens (including birth control pills) and other hormones
• Many over-the-counter medications such as cough/cold and asthma medications -- particularly when the cough/cold medicine is taken with certain antidepressants like tranylcypromine or tricyclics
• Migraine medications
• Nasal decongestants

Rebound hypertension occurs when blood pressure rises after you stop taking or lower the dose of a drug (typically a high blood pressure medication).

Symptoms

The symptoms of drug-induced hypertension are the same as those of primary hypertension, and may include:

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

Note: Hypertension usually has no symptoms.

Signs and tests

The health care provider will ask you questions about your use of drugs known to affect blood pressure measurement.

Repeated blood pressure measurements can confirm the diagnosis. Blood pressure that is consistently high is considered hypertension.

Two factors determine blood pressure measurements. Systolic blood pressure is the "top" number. It measures the pressure in the blood vessels when the heart beats. Diastolic blood pressure is the "bottom" number. It is the pressure in blood vessels when the heart is at rest.

Normal blood pressure is defined as a systolic pressure of less than 120 mmHg, and a diastolic pressure of less than 80 mmHg. A consistent rate of more than 140 mmHg systolic and more than 90 mmHg diastolic is considered high blood pressure.

Blood tests may be done to determine the levels of medications that may be causing the high blood pressure.

Treatment

The goal of treatment is to reduce your blood pressure to below 140/90 (below 130/80 if you have diabetes or kidney disease). This will lower the risk of complications.

If possible, stop taking the substance that caused your hypertension. Your health care provider may adjust your treatment if your current medications are causing hypertension and you cannot stop taking these drugs.

Medications that may be used to lower blood pressure include:

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

Have your blood pressure checked regularly (as recommended by your health care provider) to monitor its response to treatment.

Lifestyle changes may be recommended, including:

• Avoiding excess alcohol
• Dietary changes
• Exercise
• Weight loss

Expectations (prognosis)

Drug-induced hypertension is usually controllable with treatment. Treatment may need to be changed periodically.

Complications

Complications of untreated hypertension can include:

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

Calling your health care provider

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

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

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

Prevention

Be careful when taking any medication. Ask your health care provider or pharmacist about the effects, and whether the medication might interact with other drugs you are taking (even over-the-counter medications).

In people with hypertension, lowering salt (sodium) intake may be recommended. Products containing sodium (such as salt, MSG, and baking soda) may cause or worsen high blood pressure in some people.

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.

References

Kaplan NM. Systemic hypertension: therapy. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 41.

Victor RG, Kaplan NM. Systemic hypertension: mechanisms and diagnosis. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 40.