In the study, researchers examined data from 27,599 adults who completed the NHANES survey from 2009 to 2018. The average age was 46.9 years [95% CI, 46.4-47.4]; 50.9% women [95% CI, 50.2%-51.5%], 11.3% African Americans [95%CI, 9.7%-12.9%], 14.8% Hispanic individuals [95%CI, 12.6%-17.0%], and 65.3% non-Hispanic Caucasians [95%CI, 62.2%-68.3%]), of whom 49.2% (95% CI, 48.1%-50.4%) had hypertension and 35.4% (95% CI, 34.4%-36.6%) had uncontrolled hypertension.
Study results revealed that 14.9% (95% CI, 14.1%-15.6%) of U.S. adults reported using medications that may cause elevated BP, including 18.5% (95% CI, 17.5%-19.5%) of adults with hypertension. The most commonly reported classes were antidepressants (8.7%; 95% CI, 8.0%-9.5%), prescription nonsteroidal anti-inflammatory drugs (NSAIDs) (6.5%; 95% CI, 5.8%-7.2%), steroids (1.9%; 95% CI, 1.6%-2.1%), and estrogens (1.7%; 95% CI, 1.4%-2.0%).
They also noted that the use of medications that may raise BP was associated with greater odds of uncontrolled hypertension among adults not concurrently taking antihypertensives (odds ratio, 1.24; 95% CI, 1.08-1.43) but not among patients concurrently taking antihypertensives. The use of medications that may raise BP was associated with greater use of antihypertensives, among both adults with controlled hypertension (incidence rate ratio for use of one medication that may cause elevated BP, 1.27; 95% CI, 1.11-1.44) and adults with uncontrolled hypertension (incidence rate ratio, 1.13; 95% CI, 1.03-1.25).
The authors concluded that in this nationally representative survey study, 18% of U.S. adults with hypertension reported taking medications that may cause elevated BP. The use of these medications was correlated with expanded odds of uncontrolled hypertension among individuals not taking antihypertensives and greater use of antihypertensives among both patients with controlled and uncontrolled hypertension.
The limitations of the study included reliance on patient self-report of medication use, lack of reporting on medication dose and duration, and omission of OTC medications, leading to underestimation of NSAID and decongestant use.
The authors wrote, "Our findings indicate an important opportunity to improve BP control by optimizing medication regimens, an approach that has the potential to also reduce polypharmacy and medication regimen complexity. Clinicians caring for patients with hypertension should routinely screen for medications that may cause elevated BP and consider deprescribing, replacing them with safer therapeutic alternatives, and minimizing the dose and duration of use when alternatives are not available."
They also noted that many medications known to increase BP have therapeutic alternatives without this adverse effect—for example, acetaminophen in place of NSAIDs and progestin-only or nonhormonal contraceptives in place of ethinyl estradiol—containing contraceptives.
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