Medications and Supplements That Could Raise Your Blood Pressure

“This doesn’t mean that people with migraines who have hypertension won’t get relief,” says Levin. “A number of prescription medications designed to prevent migraines also control high blood pressure. These include beta-blockers, calcium channel blockers and angiotensin receptor blockers.” 

Decongestants

If you have wondered why many nasal decongestants are located in the restricted-access section of pharmacies, here’s one reason: Many of them include a recommendation to ask a doctor before use if you have a history of high blood pressure or heart disease, among other conditions.

The primary ingredients in many OTC decongestants constrict blood vessels in the nose and sinuses. Unfortunately, they also tighten blood vessels throughout the body, which may cause a marked rise in blood pressure in people with severe or uncontrolled hypertension.

Amphetamines, stimulants

Amphetamine, a psychomotor stimulant prescribed for attention deficit hyperactivity disorder (ADHD), obesity and sleep disorders, is a drug that can rapidly and acutely increase blood pressure by constricting blood vessels. Accelerated hypertension is one of the major dangers of self-administered recreational amphetamine and cocaine use.

Corticosteroids

Oral steroids, a form of corticosteroids, are used in the management and treatment of numerous medical disorders. They help reduce inflammation and suppress the immune system by both reducing the chemicals that cause inflammation and reducing immune system activity by affecting the way that blood cells work.

Steroids are prescribed to treat rheumatoid arthritis, gout, lupus, asthma, allergic rhinitis, hives, infectious and inflammatory disorders, allergic and autoimmune diseases, shock, inflammatory bowel disease, neurological disorders, anemia, prevention of graft and/or organ rejection, and skin disorders, among other uses.

Unfortunately, steroids can cause or exacerbate hypertension, especially when used in high doses for more than two weeks. Corticosteroids like prednisone can cause the retention of salt and water and loss of potassium. The ensuing change in electrolyte balance causes fluid retention, weight gain and/or bloating, elevating blood pressure. People with risk factors for high or borderline high blood pressure may be more likely to develop the condition while taking prednisone.

People with uncontrolled hypertension should not take corticosteroids if at all possible, and patients currently on corticosteroids should talk with their providers about alternatives.

Yohimbine, which is prescribed for impotence, should not be taken by any man diagnosed with or at risk for hypertension. Individuals taking high-dose corticosteroids for an extended period should monitor their blood pressure at least once a month after initiating this therapy. 

Medications under debate

Investigation into other categories of prescription drugs that can cause or increase blood pressure, or have negative interactions with blood pressure medications, represents a virtual minefield of complexities of do’s, don’ts and maybes. These include immunosuppressants, central nervous system stimulants, oral and injectable anti-obesity drugs, angiogenesis inhibitors, drugs to treat autoimmune diseases and some drugs to combat cancers.

Which supplements to avoid if you have high blood pressure 

Herbal supplements are natural. But are they safe? Three in particular should be avoided.

St. John’s Wort

St. John’s wort is associated with increased blood pressure and rapid heartbeat. It can cause very serious and potentially dangerous interactions with multiple drugs and impact their effectiveness. Mixing St. John’s wort with SSRI antidepressant pills can lead to development of life-threatening serotonin syndrome within minutes, causing high blood pressure and rapid heartbeats. 

Licorice root

Ingesting excessive amounts of licorice over a period of days to weeks can cause severe side effects, including heart attacks. The National Center for Complementary and Integrative Health (NCCIH) advises that consuming licorice root in large amounts or for long periods of time may pose a risk for people with hypertension.

Ginseng

Ginseng has been used in traditional Chinese medicine for over 5,000 years. The National Capital Poison Center advises that both Asian and American ginseng can cause changes in blood pressure. Mt. Sinai Hospital in New York City warns that “people with high blood pressure should not take Asian ginseng products without their doctor’s supervision.”

How to avoid taking medications that raise blood pressure 

• Search PIMsPlus (www.pimsplus.org), a database of prescription and OTC drugs hosted by McMaster University in Hamilton, Ontario, providing evidence-based guidelines on potentially inappropriate medications for older adults. It is a trustworthy, comprehensive resource that is regularly updated by eldercare pharmacy specialists.
  
• Provide complete medication information, including OTC meds and supplements, to each of your physicians. Patients who see multiple physicians should not assume each doctor knows what the others are doing. Communication among medical providers is a good way to determine if alternate treatments are necessary. If direct communication isn’t possible, patients should try to bring medical records with them to visits or request that electronic medical records be shared between providers.
• Use a single pharmacy whenever possible, and get to know your pharmacist. If you use multiple pharmacies, make sure that each one has a record of all your drugs, even those given to you as samples. When filling prescriptions, pharmacists will automatically be alerted if a drug may be inappropriate for your drug regimen. 

“If you take drugs for multiple health issues, such as hypertension, arthritis and diabetes, consultation with an ‘older adult’ care pharmacist may be beneficial,” advises Chad Worz, a pharmacist and CEO of the American Society of Consultant Pharmacists (ASCP). “They will evaluate all the medications that a person is taking to try to ensure appropriate, effective and safe use.”

As advocates for older adults, these pharmacists specialize in identifying, resolving and preventing problems related to medication interactions. If changes are needed — providing an alternative drug, prescribing a lower dosage or discontinuing a drug altogether because its purpose is being met by another medication — older adult care pharmacists will also notify a patient’s primary care physician of their findings and recommendations, Worz said. “They collaborate with PCPs to identify the best medication mix to achieve results and improve quality of life.”