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High blood pressure - medicine-related

Definition

Drug-induced hypertension is high blood pressure caused by a chemical substance or medicine.

Alternative Names

Hypertension - medication related; Drug-induced hypertension

Causes

Blood pressure is determined by the:

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

There are several types of high blood pressure:

• Essential hypertension has no cause that can be found (many different genetic traits contribute to essential hypertension, each one having a relatively small effect).
• Secondary hypertension occurs because of another disorder.
• Drug-induced hypertension is a form of secondary hypertension caused by the effects of a chemical substance or medicine.
• Pregnancy-induced hypertension.

Chemical substances and medicines that can cause high blood pressure include:

• Acetaminophen
• Alcohol, amphetamines, ecstasy (MDMA and derivatives), and cocaine
• Angiogenesis inhibitors (including tyrosine kinase inhibitors and monoclonal antibodies)
• Antidepressants (including venlafaxine, bupropion, and desipramine)
• Black licorice
• Caffeine (including the caffeine in coffee and energy drinks)
• Corticosteroids and mineralocorticoids
• Ephedra and many other herbal products
• Erythropoietin
• Estrogens (including birth control pills)
• Immunosuppressants (such as cyclosporine)
• Many over-the-counter medicines such as cough/cold and asthma medicines, particularly when the cough/cold medicine is taken with certain antidepressants, such as tranylcypromine or tricyclics
• Migraine medicines
• Nasal decongestants
• Nicotine
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Phentermine (a weight loss medicine)
• Testosterone and other anabolic steroids and performance-enhancing medicines
• Thyroid hormone (when taken in excess)
• Yohimbine (and Yohimbe extract)

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

• This is common for medicines that block the sympathetic nervous system like beta blockers and clonidine.
• Talk to your health care provider to see if your medicine needs to be gradually tapered before stopping.

Many other factors can also affect blood pressure, including:

• Age
• Condition of the kidneys, nervous system, or blood vessels
• Genetics
• Foods eaten, weight, and other body-related variables, including the amount of added sodium in processed foods
• Levels of various hormones in the body
• Volume of water in the body

References

Azizi M, Lorthioir A, Amar L. Resistant hypertension. In: Bakris GL, Sorrentino MJ, Laffin LJ, eds. Hypertension: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier; 2024:chap 47.

Foy MC, Vaishnav J, Sperati CJ. Drug-induced hypertension. Endocrinol Metab Clin North Am. 2019;48(4):859-873. PMIID: 31655781 pubmed.ncbi.nlm.nih.gov/31655781/.

Jurca SJ, Elliott WJ. Common substances that may contribute to resistant hypertension, and recommendations for limiting their clinical effects. Curr Hypertens Rep. 2016;18(10):73. PMID: 27671491 pubmed.ncbi.nlm.nih.gov/27671491/.

Peixoto AJ. Secondary hypertension. In: Gilbert S, ed. National Kidney Foundation Primer on Kidney Diseases. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 65.

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