“Many physicians don’t account for this, and some don’t even know about it. It’s their responsibility to be informed and make sure that their patients are aware that this is a possibility.”
When it comes to high blood pressure, many conditions and diseases – from kidney failure to endocrine tumors – become suspects. But few would suspect the garden variety pain relievers in their medicine cabinet.
In fact, many common over-the-counter and prescription medications – including certain contraceptive pills, anti-depressants, and antibiotics as well as anti-inflammatory pain relievers – can be the underlying cause of hypertension, which is a major risk factor for stroke, heart attack, and aneurisms, say cardiologists Ehud Grossman, MD, at Tel Aviv University and Franz Messerli, MD, at Columbia University, New York.
According to their recent cautionary article, published in the American Journal of Medicine (“Drug-Induced Hypertension: An Unappreciated Cause of Secondary Hypertension”):
• The chemical components of many over-the-counter and Rx drugs – including certain contraceptive pills, anti-depressants, and antibiotics as well as anti-inflammatory pain relievers – can either raise blood pressure on their own or interfere with anti-hypertensive medications.
• The harmful effects on blood pressure are more pronounced in individuals with pre-existing hypertension, those with kidney failure, and the elderly.
• And while many medications can cause this drug-induced hypertension, sometimes temporarirly and sometimes persistently, both patients and doctors remain dangerously uninformed.
Weighing the Treatment Options
“In diagnosing the causes of hypertension, over-the-counter drugs like ibuprofen are often overlooked,” Dr. Grossman says.
Patients often assume that because a medication can be obtained without a prescription, it’s relatively harmless. But that’s not always the case. In fact, many of the medications that are linked with a rise in blood pressure are quite widely used, says Prof. Grossman, whose research provides an overview of which medications are related to high blood pressure. (Interestingly, studies have indicated that while taking aspirin on awakening may elevate blood pressure slightly, a robust reduction has been observed in those receiving aspirin before bedtime.]
Although high blood pressure is a known side effect of many of the medications Grossman & Messerli mention:
• Doctors do not always account for them in their treatment plans,
• And they don’t inform patients of the potential risks associated with these medications.
It’s ultimately the doctor’s responsibility to weigh treatment options and present the best course for their patient should issues of hypertension arise, Dr. Grossman says. But patients can check proactively check the potential effects of analgesics they favor by using an online drug side-effect database or asking their pharmacist to do so.
Doctors may be advised to decrease the dosage of the drug, or add an anti-hypertensive drug to the treatment regime, Dr. Grossman says.
In any case, awareness on the part of both doctors and patients needs to be raised. “Many physicians don’t account for this, and some don’t even know about it. It’s their responsibility to be informed and make sure that their patients are aware that this is a possibility,” Dr. Grossman adds.
Cost vs Benefit
Although much of the time a course of treatment can be altered to account for the dangers of hypertension, that isn’t always the case.
For example, new anti-vascular endothelial growth factor drugs, which may increase blood pressure, block the formation of new blood vessels and arteries to solid tumors. Because the drugs are so effective in treating these malignancies, the benefit outweighs the cost, Dr. Grossman believes.
But that doesn’t mean that patients shouldn’t be watched closely for signs of hypertension. “Once a patient has won a longer life with the use of these drugs, you don’t want to expose them to problems associated with blood pressure, such as stroke,” says Prof. Grossman. There are simple ways to counteract drug-induced hypertension, such as the thoughtful addition of anti-hypertensive medications to a treatment plan, he says.
Source: Adapted from American Friends Tel Aviv University press release, Mar 20, 2012