Boston—Other medications could be exacerbating high blood pressure in patients with the condition, according to a new study.

A presentation at the American College of Cardiology’s 70th Annual Scientific Session points out that almost 20% of adults with hypertension also take other drugs that could be elevating their blood pressure.

Beth Israel Deaconess Medical Center–led researchers strongly urge that medications, including those purchased over the counter, be reviewed to make sure none could be interfering with blood pressure–lowering efforts.

The study found that antidepressants; nonsteroidal anti-inflammatory drugs (NSAIDs) that include ibuprofen and naproxen; and oral steroids used to treat conditions such as gout, lupus, rheumatoid arthritis, or after an organ transplant were the likeliest offenders. The authors report that those medications were used by 9%, 7%, and 2% of participants, respectively. Other medications associated with blood-pressure elevation include antipsychotics, certain oral contraceptives, and popular decongestants.

“These are medications that we commonly take—both over-the-counter and prescribed medications—that may have the unintended side effect of raising blood pressure and could have adverse effects on our heart health,” said lead author John Vitarello, MD, an internal medicine resident at Beth Israel Deaconess Medical Center in Boston. “We know that high blood pressure leads to cardiovascular disease, stroke and death and even small increases in blood pressure can have meaningful impacts on cardiovascular disease. Based on our findings, we need to be more aware of polypharmacy (the use of multiple medications by a single patient) in older adults who also have the highest burden of high blood pressure.”

For the study, researchers examined data from 27,599 participants in the National Health and Nutrition Examination Survey  between 2009 and 2018. About half of those had hypertension, which was defined in the study as having a blood pressure reading of more than 130 mmHg systolic or 80 mmHg diastolic or ever having been told they have high blood pressure. The average age of participants was 44 years, and slightly more than half were male.

At the same time, researchers identified medications associated with blood-pressure elevation based on those listed in the American College of Cardiology/American Heart Association guideline. They also examined use of those medications by adults with hypertension above and below recommended blood-pressure goals.

Researchers report that, among participants with high blood pressure, 19% reported using one or more blood pressure–raising medications and 4% reported using multiple medications with that effect.

Use of concurrent medications that increased blood pressure was more common in women than men—24% versus 14%. Use of those agents also occurred more often in older adults, 19% of those older than age 65 years, compared with 18% of those under age 65 years.

Dr. Vitarello suggests that deprescribing or substituting safer medications might be a way to better control blood pressure without adding more drugs to lower the levels. If no other medication options exist, the authors advise watching blood pressure closely and weighing the benefits of other medications that could affect hypertension.

Still, the study estimates that if half of U.S. adults with hypertension who are taking blood pressure–raising medications were to discontinue one of them, 560,000 to 2.2 million patients could be able to achieve their blood-pressure goals without additional therapy. Dr. Vitarello cautions that the estimates are preliminary and that individual responses to stopping blood pressure–medications are likely to vary.

He calls for more studies, especially since this one relies on self-report of high blood–pressure diagnosis and medications used.

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