18% of US adults with hypertension take medications that may raise BP

Nearly one in five U.S. adults with hypertension said they took a medication that may worsen the condition, according to a cross-sectional analysis of National Health and Nutrition Examination Survey data.

“The majority of U.S. adults with hypertension have not achieved recommended BP targets,” John Vitarello MD, MS, an internal medicine resident at Beth Israel Deaconess Medical Center, and colleagues wrote in JAMA Internal Medicine. “One often overlooked barrier to control is iatrogenic, the use of medications that are known to raise BP.”

Citing concerns that utilization of medications that increase BP “may contribute to poor BP control rates and also worsen polypharmacy,” Vitarello and colleagues analyzed data from 27,599 nonpregnant adults (mean age, 46.9 years; 50.9% women; 65.3% non-Hispanic white; 49.2% with hypertension; 35.4% with uncontrolled hypertension) who completed the NHANES from 2009 to 2018.

The researchers reported that 14.9% (95% CI, 14.1-15.6) of the entire cohort indicated that they used medications that may cause elevated BP, including 18.5% (95% CI, 17.5-19.5) of adults with hypertension. The most frequently reported types of medications the adults reported taking were antidepressants (8.7%; 95% CI, 8-9.5), prescription NSAIDs (6.5%; 95% CI, 5.8-7.2), steroids (1.9%; 95% CI, 1.6-2.1) and estrogens (1.7%; 95% CI, 1.4-2).

The use of medications that may increase BP was linked to greater odds of uncontrolled hypertension among adults who were not simultaneously taking antihypertensives (OR = 1.24; 95% CI, 1.08-1.43), according to the researchers. It was also associated with greater antihypertensive use among both adults with controlled hypertension (incidence rate ratio [IRR] for use of one medication that may cause higher BP = 1.27; 95% CI, 1.11-1.44) and those with uncontrolled hypertension (IRR = 1.13; 95% CI, 1.03-1.25).

“Our findings indicate an important opportunity to improve BP control by optimizing

medication regimens, an approach that has the potential to also reduce polypharmacy and medication regimen complexity,” Vitarello and colleagues wrote. “Clinicians caring for patients with hypertension should routinely screen for medications that may cause elevated BP and consider deprescribing, replacing them with safer therapeutic alternatives, and minimizing the dose and duration of use when alternatives are not available.”

Some possible substitutions include acetaminophen instead of NSAIDs and progestin-only or nonhormonal contraceptives instead of ethinyl estradiol-containing contraceptives, according to the researchers.