Study Highlights Many Adults Use Potentially Blood-Pressure–Raising Drugs

Per current estimates, nearly half of adult Americans have hypertension (blood-pressure values that are consistently above normal).[1] Hypertension is a major risk factor for heart disease and stroke because it damages the lining of the arteries, making them more susceptible to the buildup of plaque. The good news is that strong research evidence demonstrates that controlling high blood pressure reduces these complications.[2]

Unfortunately, certain classes of prescription and over-the-counter medications are associated with the development of hypertension, worsening control in patients with hypertension or reduction of the antihypertensive effect of blood-pressure medications.[3]

A new U.S. study that used nationally representative survey data revealed that many adults — including those with hypertension — take some of these blood-pressure–raising medications.[4] It is important to be aware of this issue given that polypharmacy (the use of multiple medications at the same time) is common among Americans with chronic conditions.

The new study was, in part, federally funded and was published in the January 2022 issue of the Journal of American Medical Association (JAMA) Internal Medicine.

Facts about hypertension in the U.S.

Hypertension is more common in men (50%) than women (44%). It also occurs in a greater percentage of non-Hispanic Black adults (56%) than non-Hispanic White adults (48%), non-Hispanic Asian adults (46%) and Hispanic adults (39%).[5]

Because hypertension usually is not associated with signs or symptoms, many people may not be aware of their condition. Therefore, measuring blood pressure is the only way to know whether a person has hypertension.

It is estimated that more than half a million deaths in the U.S. in 2019 had hypertension as a primary or contributing cause.[6]

Based on the 2017 hypertension guidelines issued by the American College of Cardiology (ACC) and the American Heart Association (AHA), most adults with hypertension in the U.S. do not have their hypertension under control.[7] This includes an estimated 24 million adults for whom lifestyle modifications only are the recommended treatment and 68 million adults for whom prescription medication (in addition to lifestyle modifications) are the recommended treatment.

The JAMA Internal Medicine study[8]

The researchers who conducted the new study used data from the National Health and Nutrition Examination Survey data (NHANES), a federal survey designed to examine the health and nutritional status of noninstitutionalized Americans.[9] This survey is unique in that it combines interviews and physical examinations.

The researchers limited the scope of their study to data pertaining to nonpregnant adult American survey participants from 2009 through 2018 who had at least one blood-pressure recording and completed the medication questionnaire.

As part of the NHANES survey, physicians measured and recorded blood pressure for the participants three times using a standardized technique. The study researchers considered survey participants to have hypertension if they met any of the following three criteria: (1) had an average systolic blood-pressure recording of 130 millimeters of mercury (mm Hg) or higher, (2) had an average diastolic blood-pressure recording of 80 mm Hg or higher, or (3) answered “yes” to the survey question, “Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?”

The participants completed the medication questionnaire through interviews conducted in their homes. Specifically, participants reported all prescription medications taken within the past 30 days and showed the interviewers their medication bottle if available. Using these responses, the study researchers identified participants’ use of medications that may cause elevated blood pressure as well as their use of medications that lower blood pressure (antihypertensives).

The researchers identified medications that may cause elevated blood pressure based on those listed in the most recent ACC/AHA hypertension guidelines.[10]

Overall, approximately 27,600 adult participants were included in the study (the average age was 47 years, and 51% were female). Based on the survey data, the researchers estimated that about half (49%) of U.S. adults had hypertension and 35% had uncontrolled hypertension (defined as an average systolic blood pressure of 130 mm Hg or higher or an average diastolic blood pressure of 80 mm Hg or higher).

The researchers estimated that 15% of U.S. adults reported taking one or more medication that may increase blood pressure. Among adults with hypertension, 19% reported using one or more of these medications.

The most frequently used medication classes that may elevate blood pressure among U.S. adults with hypertension were antidepressants (9%), prescription nonsteroidal anti-inflammatory drugs (NSAIDs, 7%), steroids (2%) and estrogens (2%). Other, less commonly used blood-pressure–raising medication classes were decongestants, stimulants, testosterones and weight-loss drugs.

The use of medications that may elevate blood pressure was associated with increased odds of uncontrolled hypertension among survey participants not concurrently taking antihypertensives, but this association was not observed in participants concurrently taking antihypertensives.

However, the use of medications that may elevate blood pressure was associated with greater use of antihypertensive medications among participants with either controlled or uncontrolled hypertension.

The findings in this study are subject to some limitations. Mainly, it lacked information about the dose and duration of used prescription medications as well as any information about over-the-counter medications because such information is not collected in the NHANES survey.

What You Can Do

If you are currently taking prescription or over-the-counter medications, make a list of these medications and ask your doctor if any of them may raise your blood pressure. If any of your medications may indeed raise your blood pressure, ask your doctor how to avoid this adverse effect. Your options likely will include taking lower doses of such drugs or switching to alternative ones that do not increase blood pressure, if possible. For example, acetaminophen (TYLENOL) may be an appropriate alternative to NSAID drugs, such as ibuprofen (ADVIL, MIDOL LIQUID GELS, MOTRIN IB, TAB-PROFEN). Similarly, progestin-only (such as norethindrone [CAMILA, ERRIN and others]) or hormone-free contraceptive methods may be an appropriate alternative to oral contraceptives that contain ethinyl estradiol (ENSKYCE, KELNOR, LORYNA and others).

Finally, if your doctor advises that you must take a potentially blood-pressure–raising drug, monitor your blood pressure frequently and discuss your blood-pressure–lowering treatment options with that doctor.[11] Do not stop any prescribed medication before consulting your doctor.
 

References

[1] Centers for Disease Control and Prevention. Estimated hypertension prevalence, treatment, and control among U.S. adults. March 22, 2021. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html. Accessed March 8, 2022.

[2] Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957-967.

[3] Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115.

[4] Vitarello JA, Fitzgerald CJ, Cluett JL, et al. Prevalence of medications that may raise blood pressure among adults with hypertension in the United States. JAMA Intern Med. 2022;182(1):90-93.

[5] Centers for Disease Control and Prevention. Facts about hypertension. September 27, 2021. https://www.cdc.gov/bloodpressure/facts.htm. Accessed March 8, 2022.

[6] Ibid.

[7] Centers for Disease Control and Prevention. Million hearts: Estimated hypertension prevalence, treatment, and control among U.S. adults. March 22, 2021. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html. Accessed March 8, 2022.

[8] Vitarello JA, Fitzgerald CJ, Cluett JL, et al. Prevalence of medications that may raise blood pressure among adults with hypertension in the United States. JAMA Intern Med. 2022;182(1):90-93.

[9] Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey. Overview. https://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/nhanes_overview_brochure.pdf. Accessed March 8, 2022.

[10] Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115.

[11] Foy MC, Vaishnav J, Sperati CJ. Drug-induced hypertension. Endocrinol Metab Clin North Am. 2019;48(4):859-873.