Many Adults with Hypertension Also Taking Medications that Raise Blood Pressure

John Vitarello, MD

A study from Beth Israel Deaconess Medical Center is underlining the importance of cross-specialty collaboration when managing patients with hypertension.

An analysis of data from the National Health and Nutrition Examination Survey (NHANES), results suggest 19% of patients with hypertension reported using at least 1 medication known to raise blood pressure.

“Even small increases in blood pressure can have meaningful impacts on cardiovascular disease. Based on our findings, we need to be more aware of polypharmacy in older adults who also have the highest burden of high blood pressure,” said lead investigator John Vitarello, MD, an internal medicine resident at Beth Israel Deaconess Medical Center (BIDMC), in a statement.

With previous research outlining the impact of hypertension on cardiovascular risk, emphasis on blood pressure management has been paramount in recent years—despite this, uncontrolled hypertension remains an issue in the US. Released ahead of the American College of Cardiology's 70th Annual Scientific Session (ACC.21), the current study was designed by VItarello and a pair of BIDMC colleagues to provide a recent estimate of the presence and impact of polypharmacy on hypertension in the US.

With this in mind, investigators designed the ACC.21 study as a serial cross-sectional analysis of NHANES data from 2009-2018. Using the ACC/AHA guidelines as reference, investigators hoped to assess medications associated with blood pressure elevation on an individual and population level. Additionally, investigators planned to use multivariate regression models with post-estimation predictions to estimate the impact of stopping blood pressure-raising medications.

Among 10,676 NHANES participants, which investigators noted is representative of 232,701,297 US adults, 47.2% (95% CI, 45.5-48.9) had hypertension. Investigators pointed out the mean age of the cohort was 56±15 years and 47.5% were female.

Upon analysis, investigators found 79.5% (95% CI, 77.3-81.8%) of patients with hypertension had blood pressure above the ACC/AHA goal of 130/80 mmHg. Additionally, 19.0% (95% CI, 17.4-20.0) of patients with hypertension reported using at least 1 or more medications that may increase blood pressure and 3.3% (95% CI, 2.4-4.1) reported using multiple.

Among patients reporting use of a medication that may raise blood pressure, the most common classes of medications used were antidepressants (8.9%; 95% CI, 7.7-10.0), non-steroidal anti-inflammatories (7.2%; 95% CI, 6.1-8.4), and steroids (2.2%; 95% CI, 1.8-2.6). When using predictive modeling, results indicated stopping a single blood pressure-raising medication could improve population-level control rates by 4.8% (95% CI, 1.4-8.1).

“Using data from a nationally representative survey, we find that nearly 1-in-5 adults with hypertension report using a medication that may raise blood pressure. Clinicians should review their prescription and over-the-counter medication use of their patients with hypertension and consider deprescribing of medications that raise blood pressure or seek therapeutic alternatives,” added Vitarello during a web briefing ahead of ACC.21.

This study, “Use and Estimated Impacts of Medications that Raise Blood Pressure Among US Adults with Hypertension: National Cross-Sectional Study,” was presented at ACC.21.