What are the most common drug induced causes of hypertension?
Nonsteroidal antiinflammatory drugs (including agents that are more selective for the second isoform of cyclooxygenase, e.g., celecoxib) are probably the most common cause of drug-induced hypertension due to their widespread, unregulated use. The mechanism is not well worked out, although alteration in intrarenal prostaglandin metabolism, sodium retention, and edema formation is likely.
Anabolic steroids, glucocorticoids, and mineralocorticoids all raise blood pressure, and the usual recommendation is to use the lowest possible dose for the shortest possible time to decrease the risk of long-term consequences (including hypertension and its sequelae).
Patients with chronic kidney disease or transplant recipients often take drugs that raise blood pressure, including cyclosporine, erythropoietin, and tacrolimus. Elevated blood pressures after use of tyrosine kinase inhibitors (given for various cancers) are associated with a favorable tumor response. These drugs are so important for the patient’s overall health that they are continued, and more antihypertensive agents are added.
Many “street” drugs can raise blood pressure acutely; acute withdrawal from nicotine, heroin, or other opioids can have the same effect. The drugs most often causing hypertension in an Emergency Department setting are cocaine, methylphenidate (or other stimulants), gamma-hydroxybutyrate, ketamine, and ergotamine. Chronic ingestion of alcohol increases the risk of hypertension; a meta-analysis of 36 trials involving 2865 participants showed a dose-dependent, significant reduction in blood pressure (by 5.5/3.0 mm Hg, on average) in those who reduced their consumption from >2 drinks/day.
A large variety of other prescription drugs (e.g., phenylpropanolamines, oral contraceptive pills, venlafaxine) can raise blood pressure. A wide variety of other drugs can interfere with antihypertensive medications either directly or via inhibition of metabolic pathways (typically hepatic cytochrome P 450 or CYP oxidoreductases). Stimulants used in the treatment of ADHD can cause hypertension. methylphenidate, dextroamphetamine, and lisdexamfetamine can cause hypertension.