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Drug-Induced Hypertension

Recognition and Management in Older Patients

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  • Adverse Effects
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Summary

This article reviews the potential of a number of drug classes to produce or aggravate hypertension, with particular emphasis on older patients. Although little information is available regarding the hypertensive effects of mineralocorticoids in the elderly, glucocorticoids usually induce an increase in blood pressure (BP) that is dosage-dependent. Nonsteroidal anti-inflammatory drugs occasionally increase BP, but this effect is not usually clinically relevant. The alleged hypertensive potential of oral antihyperglycaemic agents has not yet been substantiated.

In contrast, some antidepressants may be particularly dangerous in terms of their hypertensive complications. Although hypertension may be induced by monoamine oxidase inhibitors (MAOIs) given as monotherapy, severe hypertension is more likely to occur when MAOIs are combined with other sympathomimetic drugs. Several other drugs may also increase the risk of hypertension in elderly patients, but reliable data are lacking for most of these agents.

Elderly people who are being treated with drugs that may increase BP should be closely monitored. This is particularly true for drugs that act on the CNS.

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References

  1. Wenting GJ, Man in’t Veld AJ, Schalekamp MADH. Time-course of vascular resistance changes in mineralocorticoid hypertension of man. Clin Sci 1981; 61 Suppl. 7: 97S–100S

    PubMed  CAS  Google Scholar 

  2. Chobanian AV, Volicer L, Tifft CP, et al. Mineralocorticoid-induced hypertension in patients with orthostatic hypotension. N Engl J Med 1979; 301: 68–73

    Article  PubMed  CAS  Google Scholar 

  3. Distler A, Philipp T, Luth B, et al. Studies on the mechanism of mineralocorticoid-induced blood pressure increase in man. Clin Sci 1979; 57 Suppl. 5: 303S–5S

    PubMed  Google Scholar 

  4. Davies B, Bannister R, Sever P, et al. The pressor actions of noradrenaline, angiotensin II and saralasin in chronic autonomic failure treated with fludrocortisone. Br J Clin Pharmacol 1979; 8: 253–60

    Article  PubMed  CAS  Google Scholar 

  5. Armbruster H, Vetter W, Reck G, et al. Severe arterial hypertension caused by chronic abuse of a topical mineralocorticoid. Int J Clin Pharmacol 1975; 12: 170–3

    CAS  Google Scholar 

  6. Ghione S, Clerico A, Fommei E, et al. Hypertension and hypokalaemia caused by 9-α fluoroprednisolone in a nasal spray. Lancet 1979; I: 1301

    Article  Google Scholar 

  7. Sudhir K, Jennings GL, Esler MD, et al. Hydrocortisone-induced hypertension in humans: pressor responsiveness and sympathetic function. Hypertension 1989; 13: 416–21

    Article  PubMed  CAS  Google Scholar 

  8. Whitworth JA, Gordon D, Andrews J, et al. The hypertensive effect of synthetic glucocorticoids in man: role of sodium and volume. J Hypertens 1989; 7: 537–49

    Article  PubMed  CAS  Google Scholar 

  9. Whitworth JA. Mechanisms of glucocorticoid-induced hypertension. Kidney Int 1987; 31: 1213–24

    Article  PubMed  CAS  Google Scholar 

  10. Jackson SHD, Beevers DG, Myers K. Does long-term low-dose corticosteroid therapy cause hypertension? Clin Sci 1981; 61 Suppl.7: 381S–3S

    PubMed  CAS  Google Scholar 

  11. Baxter JD. Minimizing the side effects of glucocorticoid therapy. Adv Intern Med 1990; 35: 173–94

    PubMed  CAS  Google Scholar 

  12. Sato A, Funder JW, Okubo M, et al. Glucocorticoid-induced hypertension in the elderly: relation to serum calcium and family history of essential hypertension. Am J Hypertens 1995; 8: 823–8

    Article  PubMed  CAS  Google Scholar 

  13. Pope JE, Anderson JJ, Felson DT. A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure. Arch Intern Med 1993; 153: 477–84

    Article  PubMed  CAS  Google Scholar 

  14. Johnson AG, Nguyen TV, Day RO. Do nonsteroidal antiinflammatory drugs affect blood pressure? Ann Intern Med 1994; 121: 289–300

    PubMed  CAS  Google Scholar 

  15. De Leeuw PW. Nonsteroidal anti-inflammatory drugs and hypertension: the risks in perspective. Drugs 1996; 51: 179–87

    Article  PubMed  Google Scholar 

  16. Chrischilles EA, Wallace RB. Nonsteroidal anti-inflammatory drugs and blood pressure in an elderly population. J Gerontol 1993; 48: M91–6

    PubMed  CAS  Google Scholar 

  17. Johnson AG, Simons LA, Simons J, et al. Non-steroidal antiinflammatory drugs and hypertension in the elderly: a community-based cross-sectional study. Br J Clin Pharmacol 1993; 35: 455–9

    Article  PubMed  CAS  Google Scholar 

  18. Gurwitz JH, Avorn J, Bohn RL, et al. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA 1994; 272: 781–6

    Article  PubMed  CAS  Google Scholar 

  19. Takeuchi K, Abe K, Yasujima M, et al. No adverse effect of non-steroidal anti-inflammatory drugs, sulindac and diclofenac sodium, on blood pressure control with a calcium antagonist, nifedipine, in elderly hypertensive patients. Tohoku J Exp Med 1991; 165: 201–8

    Article  PubMed  CAS  Google Scholar 

  20. Schmitt JK, Moore JR. Hypertension secondary to chlorpropamide with amelioration by changing to insulin. Am J Hypertens 1993; 6: 317–9

    PubMed  CAS  Google Scholar 

  21. Wales JK, Grant AM, Wolf FW. The effect of tolbutamide on blood pressure. Pharmacol Exp Ther 1971; 178: 130–40

    CAS  Google Scholar 

  22. Pogátsa G, Dubecz E. The direct effect of hypoglycemic sulfonylureas on myocardial contractile force and arterial blood pressure. Diabetologia 1977; 13: 515–9

    Article  PubMed  Google Scholar 

  23. Taylor CB, Hayward C, King R, et al. Cardiovascular and symptomatic reduction effects of alprazolam and imipramine in patients with panic disorder: results of a double blind placebo-controlled trial. J Clin Psychopharmacol 1990; 10: 112–8

    Article  PubMed  CAS  Google Scholar 

  24. Glassman AH, Bigger JT. Cardiovascular effects of therapeutic doses of tricyclic antidepressants. Arch Gen Psychiatry 1981; 38: 815–20

    Article  PubMed  CAS  Google Scholar 

  25. Louie AK, Louie EK, Lannon RA. Systemic hypertension associated with tricyclic antidepressant treatment in patients with panic disorder. Am J Cardiol 1992; 70: 1306–9

    Article  PubMed  CAS  Google Scholar 

  26. Grossman E, Messerli FH. High blood pressure: a side effect of drugs, poisons, and food. Arch Intern Med 1995; 155: 450–60

    Article  PubMed  CAS  Google Scholar 

  27. Montastruc JL, Chamontin B, Senard JM, et al. Pseudophaeochromocytoma in parkinsonian patient treated with fluoxetine plus selegiline [letter]. Lancet 1993; 341: 555

    Article  PubMed  CAS  Google Scholar 

  28. Beasley CM, Masica DN, Heiligenstein JH, et al. Possible monoamine oxidase-serotonin uptake inhibitor interaction: fluoxetine clinical data and preclinical findings. J Clin Psychopharmacol 1993; 13: 312–20

    Article  PubMed  Google Scholar 

  29. Fallon B, Foote B, Walsh BT, et al. ‘Spontaneous’ hypertensive episodes with monoamine oxidase inhibitors. J Clin Psychiatry 1988; 49: 163–5

    PubMed  CAS  Google Scholar 

  30. Lefebvre H, Richard R, Noblet C, et al. Life-threatening pseudo-phaeochromocytoma after toloxatone, terbutaline, and phenylephrine. Lancet 1993; 341: 555–6

    Article  PubMed  CAS  Google Scholar 

  31. Coulter DM, Pillans PI. Hypertension with moclobemide [letter]. Lancet 1995; 346: 1032

    Article  PubMed  CAS  Google Scholar 

  32. Boyd IW. Hypertension with moclobemide [letter; comment]. Lancet 1995; 346: 1498

    Article  PubMed  CAS  Google Scholar 

  33. Laux G, Philipp M, Kohnen R. Hypertension with moclobemide [letter]. Lancet 1996; 347: 1330

    Article  PubMed  CAS  Google Scholar 

  34. Drayer JIM, Keim HJ, Weber MA, et al. Unexpected pressor responses to propranolol in essential hypertension. Am J Med 1976; 60: 897–903

    Article  PubMed  CAS  Google Scholar 

  35. Young E, Levey BA, Shapiro AP. Paradoxical hypertension from clonidine. Ann Intern Med 1984; 101: 282–3

    PubMed  CAS  Google Scholar 

  36. Hui KK. Hypertensive crisis induced by interaction of clonidine with imipramine. J Am Geriatr Soc 1983; 31: 164–5

    PubMed  CAS  Google Scholar 

  37. Lake CR, Gallant S, Masson E, et al. Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports. Am J Med 1990; 89: 195–208

    Article  PubMed  CAS  Google Scholar 

  38. Clyburn EB, DiPette DJ. Hypertension induced by drugs and other substances. Sem Nephrol 1995; 15: 72–86

    CAS  Google Scholar 

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  1. Department of Medicine, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Peter W. de Leeuw

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  1. Peter W. de Leeuw
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de Leeuw, P.W. Drug-Induced Hypertension. Drugs & Aging 11, 178–185 (1997). https://doi.org/10.2165/00002512-199711030-00003

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