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High blood pressure - medicine-related

Hypertension - medication related; Drug-induced hypertension

Drug-induced hypertension is high blood pressure caused by a chemical substance or medicine.

Causes

Blood pressure is determined by the:

  • Amount of blood the heart pumps
  • Condition of the heart valves
  • Pulse rate
  • Pumping power of the heart
  • Size and condition of the arteries

There are several types of high blood pressure:

  • Essential hypertension has no cause that can be found (many different genetic traits contribute to essential hypertension, each one having a relatively small effect).
  • Secondary hypertension occurs because of another disorder.
  • Drug-induced hypertension is a form of secondary hypertension caused by a response to a chemical substance or medicine.
  • Pregnancy-induced hypertension.

Chemical substances and medicines that can cause high blood pressure include:

  • Acetaminophen
  • Alcohol, amphetamines, ecstasy (MDMA and derivatives), and cocaine
  • Angiogenesis inhibitors (including tyrosine kinase inhibitors and monoclonal antibodies)
  • Antidepressants (including venlafaxine, bupropion, and desipramine)
  • Black licorice
  • Caffeine (including the caffeine in coffee and energy drinks)
  • Corticosteroids and mineralocorticoids
  • Ephedra and many other herbal products
  • Erythropoietin
  • Estrogens (including birth control pills)
  • Immunosuppressants (such as cyclosporine)
  • Many over-the-counter medicines such as cough/cold and asthma medicines, particularly when the cough/cold medicine is taken with certain antidepressants, such as tranylcypromine or tricyclics
  • Migraine medicines
  • Nasal decongestants
  • Nicotine
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Phentermine (a weight loss medicine)
  • Testosterone and other anabolic steroids and performance-enhancing drugs
  • Thyroid hormone (when taken in excess)
  • Yohimbine (and Yohimbe extract)

Rebound hypertension occurs when blood pressure rises after you stop taking or lower the dose of a drug (typically a medicine to lower high blood pressure).

  • This is common for medicines that block the sympathetic nervous system like beta blockers and clonidine.
  • Talk to your provider to see if your medicine needs to be gradually tapered before stopping.

Many other factors can also affect blood pressure, including:

  • Age
  • Condition of the kidneys, nervous system, or blood vessels
  • Genetics
  • Foods eaten, weight, and other body-related variables, including the amount of added sodium in processed foods
  • Levels of various hormones in the body
  • Volume of water in the body

References

Bobrie G, Amar L, Faucon A-L, Madjalian A-M, Azizi M. Resistant hypertension. In: Bakris GL, Sorrentino MJ, eds. Hypertension: A Companion to Braunwald's Heart Disease. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 43.

Charles L, Triscott J, Dobbs B. Secondary hypertension: discovering the underlying cause. Am Fam Physician. 2017;96(7):453-461. PMID: 29094913 pubmed.ncbi.nlm.nih.gov/29094913/.

Grossman A, Messerli FH, Grossman E. Drug induced hypertension--an unappreciated cause of secondary hypertension. Eur J Pharmacol. 2015;763(Pt A):15-22. PMID: 26096556 pubmed.ncbi.nlm.nih.gov/26096556/.

Jurca SJ, Elliott WJ. Common substances that may contribute to resistant hypertension, and recommendations for limiting their clinical effects. Curr Hypertens Rep. 2016;18(10):73. PMID: 27671491 pubmed.ncbi.nlm.nih.gov/27671491/.

Peixoto AJ. Secondary hypertension. In: Gilbert SJ, Weiner DE, eds. National Kidney Foundation's Primer on Kidney Diseases. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 66.

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    Review Date: 10/2/2020

    Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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