According to data from the National Health and Nutrition Examination Survey (NHANES), many hypertensive patients can inadvertently take drugs that increase blood pressure (BP).
The prevalence of such drug use was 14.9% across survey cycles from 2009 to 2018, reaching 18.5% of adults with hypertension, reported Timothy Anderson, MD, MAS, from Beth Israel Deaconess Medical Center in Boston, and colleagues from JAMA Internal Medicine.
Drugs that increase BP were determined according to the 2017 guidelines of the American College of Cardiology and the American Heart Association. The most common taken by NHANES participants were antidepressants (8.7%), prescription nonsteroidal anti-inflammatory drugs (NSAIDs; 6.5%), steroids (1.9%), and estrogen (1 , 7%).
“The majority of American adults with hypertension did not meet recommended BP goals. An often overlooked barrier to control is iatrogenic use of drugs known to increase BP. polypharmacy, the use of drugs that increase BP can contribute to poor BP control rates and also worsen polypharmacy, ”the investigators said.
The use of these drugs has been associated with greater use of antihypertensive drugs in people with controlled and uncontrolled hypertension. Adults not taking antihypertensive drugs concurrently were more likely to have uncontrolled hypertension if they took these drugs (OR 1.24, 95% CI 1.08-1.43).
“Many drugs known to increase BP have treatment alternatives without this side effect – for example, acetaminophen in place of NSAIDs and progestin-only or non-hormonal contraceptives in place of contraceptives containing ethinyl estradiol,” said noted Anderson’s group.
“Thus, our results indicate an important opportunity to improve BP control by optimizing treatment regimens, an approach that has the potential to also reduce polypharmacy and the complexity of treatment regimens,” suggested the authors.
“Clinicians caring for patients with hypertension should systematically seek out drugs that may increase BP and consider deprescribing them, replacing them with safer treatment alternatives, and minimizing the dose and duration of use when alternatives are not available, ”they said.
The cross-sectional study included 27,599 adult NHANES participants (mean age 46.9; 50.9% female).
Hypertension was defined as systolic BP of 130 mm Hg or greater or diastolic BP of 80 mm Hg or greater. The prevalence of hypertension and uncontrolled hypertension was 49.2% and 35.4%, respectively.
Prescription drug use was obtained from home interviews in the NHANES.
Anderson and colleagues acknowledged their reliance on self-reported drug use and the lack of data on the dose, duration, and use of over-the-counter drugs.
NHANES was the basis of an earlier report suggesting a decline in both awareness and control of hypertension in recent years.
Anderson disclosed relationships with and / or support from Alosa Health, the National Institute on Aging, the American College of Cardiology, and the Boston Claude D. Pepper Older Americans Independence Center.
A co-author revealed support from the National Heart, Lung, and Blood Institute.