Drug-Induced Hypertension

Drug-Induced Hypertension

Article
Brain & Nerve
Eye & Vision
+4
Contributed byKrish Tangella MD, MBAMay 22, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Drug-Induced High Blood Pressure
  • Hypertensive Disease due to Drugs
  • Secondary Hypertension caused by Medications

What is Drug-Induced Hypertension? (Definition/Background Information)

  • The human heart is responsible for pumping fresh, oxygen-rich blood to various organs of the body. The oxygen-rich blood reaches the organs through a system of blood vessels called the arteries. Blood pressure (BP) refers to the pressure with which blood flows through these vessels
  • When this pressure exceeds the normal upper limit of flow pressure, it is known as hypertension (or high blood pressure)
  • There are two components of blood pressure:
    • Diastolic blood pressure: It is the pressure with which blood flows in the arteries, when the heart is in a relaxed state
    • Systolic blood pressure: The pressure flow in the arteries, measured when blood is pumped into them by the heart
  • Blood pressure can be classified as follows: All the values of blood pressure measurements are expressed in millimeters of mercury (or mm Hg).
    • Normal: Systolic BP less than 120; diastolic BP less than 80
    • Prehypertension: Systolic BP between 120-139; diastolic BP between 80-89       
  • Hypertension may be classified as follows:
    • Stage 1 hypertension: Systolic BP between 140-159; diastolic BP between 90-99
    • Stage 2 hypertension: Systolic BP greater than 160; diastolic BP greater than 100     
  • Secondary hypertension is a type of high blood pressure that is caused by a medical condition. If hypertension occurs in individuals younger than 65 years of age, a secondary cause of high blood pressure should be ruled out
  • Drug-Induced Hypertension is a type of secondary hypertension. A variety of therapeutic agents can increase blood pressure. It can be either transient or persistent
  • Usually, Drug-Induced Hypertension is of a transient nature, and a careful evaluation of the individual’s drug regimen may help identify the drug causing high blood pressure
  • The common signs and symptoms of Drug-Induced Hypertension include headache, light-headedness, nausea, vomiting, muscle tremors, and excessive sweating. The complications of hypertension may develop over a long period of time. They occur due to an inadequate flow of blood to various body organs
  • Stoppage of the drug responsible for causing high blood pressure can usually control the symptoms associated with Drug-Induced Hypertension. Individuals, who are being treated with drugs that may increase their BP, should be closely monitored
  • The prognosis of Drug-Induced Hypertension is typically very good, if the condition is managed appropriately

Who gets Drug-Induced Hypertension? (Age and Sex Distribution)

  • Drug-Induced Hypertension can affect any individual taking medications that can cause hypertension
  • Males are more likely to be affected by this condition than females
  • The condition is observed worldwide; all racial and ethnic groups can be affected

What are the Risk Factors for Drug-Induced Hypertension? (Predisposing Factors)

Following are the risk factors for Drug-Induced Hypertension:

  • Drug-Induced High Blood Pressure is more common in individuals in whom sodium excretion is already impaired, because of kidney dysfunction
  • Drugs, such as corticosteroids, oral contraceptive pills, cyclosporine, and antidepressants, are known to increase the blood pressure
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) have a variety of adverse effects. They can increase the blood pressure and also influence the overall cardiovascular risk
  • A chronic use of oral contraceptive pills will slightly increase the systemic blood pressure in most women
  • The deleterious effect of therapeutic agents is more pronounced in patients with preexisting hypertension, in those with kidney failure, and in the elderly adults
  • Rebound increase in BP may also be seen in those who abruptly discontinue antihypertensive drugs. Rebound hypertension occurs when drugs that lower one’s blood pressure are discontinued or stopped

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Hypertension? (Etiology)

  • Drug-Induced Hypertension could either result from an intrinsic pressor effect of the drug, or from an interference with the cardiovascular control system. This means that the condition can be caused either due to the chemical nature of the drug, or by causing the cardiovascular system to increase the blood pressure
  • Some drugs either cause sodium retention by the kidneys, or extracellular volume expansion. Oral contraceptives that contain both estrogen and progesterone are responsible for this effect
  • The hypertensive effect of NSAIDs is dose dependent and probably involves inhibition of COX-2 in the kidneys, which reduces sodium excretion and increases intravascular volume
  • Hypertension is a common adverse effect of erythropoietin (EPO) treatment that is observed among patients with chronic kidney disease. The risk of hypertension is increased by targeting higher hemoglobin concentrations
  • Cyclosporine has been a mainstay of immuno-suppression in organ transplantation. Blood pressure increases soon after the administration of cyclosporine. The mechanism underlying this disorder is complex and involves the release of vasoconstrictors (substances that constrict the blood vessels) in blood

What are the Signs and Symptoms of Drug-Induced Hypertension?

The signs and symptoms of Drug-Induced Hypertension develop when the blood pressure (BP) is very high, and is due to a decrease in the supply of blood to important organs of the body. Extremely high values of blood pressure in the range of, systolic > 220 mm Hg and diastolic > 120 mm Hg, can lead to any one of the following conditions:

  • Hypertensive urgency: It is defined as BP in the range of, systolic > 220 mm Hg and diastolic > 120 mm Hg, without damage to any of the body organs
  • Hypertensive emergency: It is defined as BP in the range of, systolic > 220 mm Hg and diastolic > 120 mm Hg, with evidence of organ damage

The following signs and symptoms may occur with constantly elevated levels of high blood pressure:

  • Headache: It may be due to a decreased supply of nutrients, or due to bleeding in the brain
  • Nausea and vomiting
  • Anxiety
  • Excessive sweating
  • Muscle tremors
  • Altered mental status
  • Light-headedness, which may progress to black-outs
  • Changes in visual acuity, causing vision defects
  • When blood supply to the heart decreases, one may experience chest pain
  • Urinary symptoms can occur from damage to the kidney vessels, which in turn can lead to spilling of blood in urine
  • Some individuals may also complain of a feeling of rapid heartbeats, called palpitations

How is Drug-Induced Hypertension Diagnosed?

The diagnosis of Drug-Induced Hypertension may involve the following tests and procedures:

  • A diagnosis of Drug-Induced High Blood Pressure is made when the patients are prescribed drugs that are known to cause hypertension and the presence of certain signs and symptoms (aforementioned)
  • Hypertension may be diagnosed by measuring the blood pressure in the arms, using a device known as a sphygmomanometer. The reading is recorded in terms of systolic and diastolic blood pressure. Once an elevated reading of BP is obtained, repeated measurements (minimum of 3 times) are needed to classify it is as hypertension
  • If hypertension occurs in individuals younger than 65 years of age, a secondary cause of high blood pressure has to be ruled out

Some other tests that the physician might order include those that are meant to eliminate other probable causes of high blood pressure. These tests include:

  • Blood test to determine blood levels of sodium and potassium
  • Urinary tests to detect any kidney disorders
  • Determination of blood sugar levels
  • Echocardiography to identify any abnormality in the structure of heart
  • Ultrasound of the kidneys to detect any abnormal blood flow and/or changes in the structure of the kidneys
  • Comprehensive eye exam
  • Head CT (in case of hypertensive emergencies)
  • EKG (ECG) to determine the effects of high BP on the heart

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Hypertension?

The complications of hypertension may develop over a long period of time. They are due to an inadequate flow of blood to the various body organs. Following are some of the complications of Drug-Induced Hypertension:

  • Effects on the heart:
    • With long-standing hypertension, the heart may increase in size due to a condition known as left ventricular hypertrophy (the left chamber of the heart becomes bigger in size). This leads to an increased load on the heart
    • It may progress to a heart attack or even heart failure
  • Effects on the eye:
    • If high blood pressure is left untreated, a sequence of change takes place in the eye. This leads to damage of the retina, which is responsible for image formation
    • This may eventually end-up as blindness, a condition which is often irreversible       
  • Effects on the brain:
    • Due to an increased force of blood flow, the vessels supplying blood to the brain may rupture and cause bleeding in the brain
    • This is known as a stroke and it may cause permanent neurological defects in the body       

Individuals with high BP and those who also smoke are at an increased risk of developing a condition known as an aneurysm:

  • An aneurysm is the dilatation (expansion like a balloon) of the blood vessel wall, due to a weakening of the vessel wall
  • The blood vessels may rupture and cause uncontrolled bleeding

How is Drug-Induced Hypertension Treated?

The management of Drug-Induced Hypertension consists of:

  • Consulting the healthcare provider when the above-mentioned symptoms are observed. The physician may adjust the treatment of the current drug causing the high blood pressure. If required, the drug causing hypertension is stopped.

Lifestyle modifications:

  • Weight loss: It is the most important factor in the management of high blood pressure
  • Smoking cessation
  • Reduced alcohol intake
  • Regularly exercising and consuming a low-fat, low-salt diet

Medications used to lower blood pressure may include:

  • Alpha blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta blockers
  • Calcium channel blockers
  • Central alpha agonists
  • Diuretics

How can Drug-Induced Hypertension be Prevented?

Various ways to avoid developing hypertension include:

  • Maintaining a healthy weight
  • Eating a diet low in salt, sugar, and fat
  • Exercising regularly
  • Smoking cessation
  • Limiting the intake of alcohol
  • Taking the prescribed medications regularly
  • Managing stress using relaxation techniques

Individuals who are being treated with medications that may increase the blood pressure should be closely monitored. Generally, the BP will return to normal levels after discontinuation of the medication.

What is the Prognosis of Drug-Induced Hypertension? (Outcomes/Resolutions)

  • Drug-Induced Hypertension is usually reversible and has a good prognosis if identified in the initial stages
  • A timely diagnosis and management of hypertension may prevent certain grave complications associated with it. Once complications develop, they might be irreversible; also, the prognosis is then dependent upon the extent of damage to the organs (if any)
  • The greater the duration for which an individual has increased blood pressure and the greater the level of hypertension, the poorer is the prognosis; especially if the condition is not treated adequately

Additional and Relevant Useful Information for Drug-Induced Hypertension:

Be aware of the medication that may increase the blood pressure. The following drugs can potentially increase the BP:

  • Amphetamines, cocaine
  • Corticosteroids
  • Cyclosporine
  • Erythropoietin
  • Oral contraceptive pills
  • Antidepressants such as MAO inhibitors
  • Migraine medications
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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