May 7, 2021 -- Nearly 1 out of 5 American adults with high blood pressure is on a prescription drug known to raise blood pressure, based on analysis of more than 27,000 people in a recent report from the recurring National Health and Nutrition Examination Survey.

Nearly half of the patients in the survey had high blood pressure and of them, 19% reported using a prescription drug known to increase blood pressure. The most widely used drugs were antidepressants, used by 9%; followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 7%; steroids, 2%; and estrogens, 1.7%, John Vitarello, MD, said during a press briefing on reports from the American College of Cardiology.

He and his colleagues estimated that this use of prescription drugs known to raise blood pressure could be what stands in the way of 560,000 to 2.2 million Americans from having their blood pressure under control said Vitarello, a researcher at Beth Israel Deaconess Medical Center in Boston.

He also said the study looked only at prescription drugs and did not examine over-the-counter drug use, which may be especially relevant for the many people who regularly take NSAIDs.

Vitarello cautioned that keeping patients with high blood pressure on drugs that raise their blood pressure can lead to "prescribing cascades," where taking drugs that boost blood pressure results in need for more intensive treatment.

An Opportunity for NSAID Alternatives

"This study hopefully raises awareness that there is a very high use of medications that increase blood pressure, and use of OTC agents could increase the rate even higher," said Eugene Yang, MD, a cardiologist and codirector of the Cardiovascular Wellness and Prevention Program of the University of Washington.

Substituting for certain antidepressants may often not be realistic, but an opportunity exists for reducing NSAID use, a class of drugs also linked with an increased risk for bleeding and other side effects, Yang said. Minimizing use of NSAIDs including ibuprofen (such as Advil) and naproxen (Aleve) "is something to think about," he suggested.

"The effect of NSAIDs on blood pressure is not well studied and can vary from person to person," Vitarello said, who added that higher NSAID dosages and longer use likely increase the risk for an effect on blood pressure. One reasonable option is to encourage patients to use other pain relievers, like acetaminophen.