High blood pressure caused by a response to using, or stopping the use of, a chemical substance, drug, or medication.

Alternative Names

Hypertension - medication related

Causes, incidence, and risk factors

Blood pressure is determined by the amount of blood that is pumped by the heart, the pumping power of the heart, the condition of the heart valves, and the size and condition of the arteries. Many other factors can also affect blood pressure, including:

The volume of water in the body

Foods eaten, weight, and other body-related variables

Condition of the kidneys, nervous system, or blood vessels

Levels of various hormones in the body

Caucasian men and African Americans of both sexes have a higher incidence of significant hypertension . There are several types of high blood pressure. Essential hypertension has no identifiable cause. Secondary hypertension occurs because of another disorder. Drug-induced hypertension is a form of secondary hypertension caused by a response to medication. Drugs which can cause hypertension include:

Alcohol, amphetamines, ecstasy (MDMA and derivatives), and cocaine.

Corticosteroids and other hormones (e.g., estrogens including birth control pills).

Migraine medications.

Cyclosporine.

Erythropoietin (used to correct anemia related to chronic diseases -- such as kidney failure, cancer, and HIV).

Nasal decongestants.

Sympathomimetic medications (found in many over-the-counter medications such as

cough /cold medications and medications for asthma ) particularly when the cough/cold medicine is taken in conjunction with tranylcypromine or tricyclic antidepressants, and others.

Antihypertensive medications (such as clonidine), when a person stops taking them, particularly if the medication is not tapered off. This is called rebound hypertension.

Signs and tests

The health care provider will ask questions regarding the use of drugs which are known to affect blood pressure . Blood pressure measurements, repeated over time, are used to confirm the diagnosis. Blood pressure that is consistently elevated is considered hypertension. Two factors determine blood pressure measurements. Systolic blood pressure is the "top" number and is a measurement of the pressure in the blood vessels when the heart beats. Diastolic blood pressure is the "bottom" number which reflects the pressure in blood vessels when the heart is at rest. A consistent rate of more than 140 mm Hg systolic and more than 90 mm Hg diastolic is considered high blood pressure. Tests to determine the cause of the problem may include blood tests to determine the levels of suspect medications.

Treatment

The goal of treatment is to reduce blood pressure , which will lower the risk of complications. The goal is blood pressure of 130/85 or less. In patients with kidney disease and protein in the urine, the goal is 125/75 or less. Whenever possible, the substance that caused the hypertension is discontinued. Adjustments may be made in medical therapy if current medications are causing hypertension and discontinuation of these drugs is not advisable. Medications that may be used to modify blood pressure include:

Diuretics

Potassium replacements

Beta blockers

Calcium channel blockers

Angiotensin-converting

enzyme (ACE) inhibitors

Angiotensin receptor blockers (ARB)

Direct vasodilators

Diazoxide, nitroprusside (if

acute hypertension), or other intravenous antihypertensive medications may be used. Have your blood pressure checked at regular intervals (as recommended by your health care provider) to monitor its condition and response to treatment. Lifestyle changes may be recommended, including such things as weight loss , exercise , avoidance of excess alcohol intake, and dietary adjustments.

Expectations (prognosis)

Drug-induced hypertension is usually controllable with treatment, which may require periodic adjustment.

Complications

Complications of untreated hypertension :

Heart attacks

Congestive heart failure

Other heart damage

Blood vessel damage

Kidney damage

Stroke

Loss of vision

Calling your health care provider

Call your health care provider if you believe you may have

hypertension .

Prevention

Use caution when ingesting any substance. If you are unsure of the likely effects and of interactions with other medications that you are already taking, consult your health care provider or pharmacist before using the substance or medication. In people with hypertension , modification of sodium intake may be recommended. Products containing sodium (e.g., salt, MSG, and baking soda) often have little effect in people without hypertension, but may have a profound effect in those with hypertension. If your doctor suspects drug-induced hypertension, it is important to discuss all drug use -- including alcohol and other recreational drugs -- so that the condition can be properly diagnosed.