Prescription drugs, over-the-counter medications and supplements, recreational substances all have the potential to impact blood pressure (BP). BP changes caused by drugs or other agents have been associated with triggering hypertension (HTN), worsening control in persons with HTN, or reducing the effect of antihypertensive therapy.
The Guideline Topline in the following slides is an at-a-glance summary of agents and classes of drugs to avoid, stop, or consider carefully listed in the American Heart Association and American College of Cardiology's 2017 Guideline for the Detection, Evaluation, and Management of High Blood Pressure in Adults . It's a quick review for primary care.
Alcoholic beverages, amphetamines, and some antidepressants may elevate blood pressure in adults. Limit alcohol and discontinue or consider alternative approaches for the 2 medication classes.
Reduce potential for blood pressure elevation by prescribing limited intake of caffeine and coffee abstinence for patients with uncontrolled HTN. Decongestants should be used for the shortest time possible or replaced with alternative therapies.
Avoid use of oral contraceptives in women wtih uncontrolled hypertension. In others, use low-dose or progestin-only formulations.
NSAIDs and systemic corticosteroid use should be avoided or limited whenever possible; consider alternatives to both, as appropriate.
Consider converting treatment with cyclosporine to tacrolimus which may have less effect on BP. Patients should avoid completely/discontinue use of herbal supplements and all recreational drugs to avoid BP spikes.
When treatment for cancer requires use of angiogenesis inhibitors or tyrosine kinase inhibitors, initiate antihypertensive therapy or intensify therapy on board.