Brookline, MA--Use of medications that have the potential to increase blood pressure was associated with increased odds of uncontrolled hypertension among those not taking antihypertensives, according to a recent study.

The article in JAMA Internal Medicine also found that those patients had more prescriptions for antihypertensives whether their BP was controlled or uncontrolled.

In a nationally representative survey study, 18% of U.S. with hypertension reported taking medications that may cause elevated BP, according to the Beth Israel Deaconess Medical Center-led authors.

"The majority of US adults with hypertension have not achieved recommended blood pressure (BP) targets," the authors write. "One often overlooked barrier to control is iatrogenic, the use of medications that are known to raise BP. Given national trends of increasing polypharmacy, use of medications that raise BP may contribute to poor BP control rates and also worsen polypharmacy."

For the cross-sectional study, researchers examined National Health and Nutrition Examination Survey (NHANES) data to quantify the prevalence of use of medications that can raise BP and assess associations with BP control and antihypertensive use.

The study team analyzed five survey cycles of NHANES, a nationally representative biannual survey of the U.S. noninstitutionalized population. Participants were non-pregnant adults. Home interviews were used to determine prescription medication use, and 2017 American College of Cardiology and American Heart Association guidelines informed which antihypertensives and medications can cause elevated BP.

Researchers defined hypertension as an average systolic BP of 130 mm Hg or higher, average diastolic BP of 80 mm Hg or higher, or answering "yes" to the question, "Have you ever been told by a doctor or other health professional that you had hypertension, also called high blood pressure?" Uncontrolled hypertension was defined as an average systolic BP of 130 mm Hg or higher or an average diastolic BP of 80 mm Hg or higher.

Included in the study population were 27,599 adults, slightly more than half women, with a mean age of 46. Of those, 11.3% were Black, 14.8% Hispanic and 65.3% non-Hispanic White. Almost half 49.2% (95% CI, 48.1%-50.4%), had hypertension and 35.4% (95% CI, 34.4%-36.6%) had uncontrolled hypertension.

The study points out that 14.9% (95% CI, 14.1%-15.6%) of U.S. adults reported using medications that may cause elevated BP, including 18.5% (95% CI, 17.5%-19.5%) of adults with hypertension. Antidepressants (8.7%; 95% CI, 8.0%-9.5%) were the most commonly reported class, followed by prescription nonsteroidal anti-inflammatory drugs (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%-2.0%).

"The use of medications that may raise BP was associated with greater odds of uncontrolled hypertension among adults not concurrently taking antihypertensives (odds ratio, 1.24; 95% CI, 1.08-1.43) but not among patients concurrently taking antihypertensives," researchers conclude. "The use of medications that may raise BP was associated with greater use of antihypertensives, among both adults with controlled hypertension (incidence rate ratio for use of 1 medication that may cause elevated BP, 1.27; 95% CI, 1.11-1.44) and adults with uncontrolled hypertension (incidence rate ratio, 1.13; 95% CI, 1.03-1.25)."

The authors suggest alternative prescribing could be an answer, explaining, "Many medications known to raise BP have therapeutic alternatives without this adverse effect for example, acetaminophen in place of NSAIDs and progestin-only or nonhormonal contraceptives in place of ethinyl estradiolÐcontaining contraceptives. Thus, 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. 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."

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