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Blood Pressure Medications for Lupus

Medically Reviewed by Melinda Ratini, DO, MS on March 08, 2022

If you have lupus, you’re at a higher risk for a heart attack or stroke. Twenty-five to thirty percent of people with lupus also have high blood pressure. To lower your likelihood of cardiovascular issues and other problems, it’s important to treat your high blood pressure.

There are certain drugs that aren’t safe to take if you have high blood pressure and lupus. The good news is there are other options to keep both conditions in check.

How Are Lupus and High Blood Pressure Related?

Cardiovascular disease, which can be caused by high blood pressure, is the leading cause of death in those with lupus. This is because lupus affects your heart and blood vessels, which are a part of your cardiovascular system.

The top causes of high blood pressure in those with lupus are:

  • Obesity
  • Kidney disease
  • Long-term steroid use

The use of certain medications such as cyclosporine (Gengraf, Neoral, Sandimmune), an immunosuppressive for lupus, can also cause your blood pressure to rise.

It may be difficult to keep your blood pressure controlled if you have lupus. This can be because of certain drugs that can be used, like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen or steroids like prednisone. These medications lower the blood flow to your kidneys, cause fluid retention, and may cause high blood pressure and renal failure.

In addition, people with lupus-related kidney disease can also have a higher blood pressure.

It’s important to keep your blood pressure at a normal level, especially if you have lupus. Experts say that less than 120/88 is a good goal.

Which Blood Pressure Medications Can You Take With Lupus?

Talk to your doctor about which high blood pressure drugs are best for people with lupus. This could include:

Diuretics. These drugs help your kidneys get rid of extra fluid and sodium. Your kidneys help maintain your blood pressure. They control the balance of salts and water in your blood. Too much of these in your kidneys can cause your blood pressure to go up. Doctors prescribe diuretics to lower high blood pressure. They can also allow for other drugs to work better.

You doctor may have you try diuretics like:

  • Chlorthalidone (Hygroton)
  • Chlorothiazide (Diuril)
  • Hydrochlorothiazide (Microzide, Oretic)
  • Indapamide (Lozol)
  • Bumetanide (Bumex)
  • Furosemide (Lasix)
  • Torsemide (Demadex)
  • Amiloride (Midamor)
  • Spironolactone (Aldactone, Carospir)
  • Triamterene and hydrochlorothiazide (Dyazide, Maxzide)

Angiotensin-converting enzyme (ACE) inhibitors. Your doctor may prescribe an ACE inhibitor to control your blood pressure, lower protein in your urine, treat heart failure, and prevent kidney damage. It allows your heart to easily pump blood by lessening blood flow resistance and enlarging your blood vessels.

If you have lupus, ACE inhibitors can help in two ways: The drugs control blood pressure and lower the protein in your urine, which helps avoid kidney scarring (which is especially important in people who have kidney-involved lupus).

ACE inhibitors include:

  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Qbrelis, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)

Angiotensin-II receptor antagonists/angiotensin receptor blockers (ARBs). These medications are similar to ACE inhibitors. ARBs can help manage high blood pressure, treat heart failure, lower the protein in your urine, and help prevent kidney failure.

Angiotensin-II receptor antagonists/angiotensin receptor blockers include:

  • Candesartan (Atacand)
  • Eprosartan (Teveten)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan, Prexxartan)

Beta-blockers. Your doctor may give you a beta-blocker to treat your abnormal heart rhythm, help with angina (chest pain that happens when your heart muscle doesn’t get enough blood), lower your blood pressure, or to improve your health if you’ve had a heart attack.

Beta-blockers include:

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Betaxolol
  • Bisoprolol/hydrochlorothiazide (Ziac)
  • Bisoprolol (Zebeta)
  • Carvedilol (Coreg)
  • Metoprolol (Lopressor, Toprol XL)
  • Nadolol (Corgard)
  • Nebivolol (Bystolic)
  • Propranolol (Inderal LA, Inderal XL, InnoPran X)
  • Sotalol (Betapace)
  • Timolol

Calcium channel blockers (calcium antagonists). These drugs help treat angina, fix some arrhythmias (an abnormal heart rhythm), or lower blood pressure. You can also take calcium channel blockers for Raynaud’s syndrome (a condition that causes coldness or numbness in your hands and feet).

Calcium channel blockers include:

  • Amlodipine (Norvasc)
  • Diltiazem (Cardizem, Cartia, Dilacor, Tiazac)
  • Felodipine (Plendil)
  • Nifedipine (Adalat CC, Procardia XL)
  • Nimodipine (Nymalize)
  • Nisoldipine (Sular)
  • Verapamil (Calan, Isoptin, Verelan)

Alpha-blockers. Your doctor may give you these drugs to treat Raynaud’s syndrome, high blood pressure, scleroderma (diseases that cause your skin to become tight and hard), or other conditions. Alpha blockers can also help with trouble peeing because of benign prostatic hyperplasia (BPH).

These drugs usually aren’t the first type of treatment your doctor will give to you for high blood pressure. This is because experts haven’t proven that these drugs lower your long-term risk of heart attack or stroke. But you may use them in addition to other medications to control your blood pressure.

Alpha-blockers include:

  • Doxazosin mesylate (Cardura)
  • Prazosin hydrochloride (Minipress)
  • Prazosin and polythiazide (Minizide)
  • Terazosin hydrochloride
  • Tamsulosin (Flomax)

Central alpha agonists/central-acting agents. These drugs can help lower your heart rate and blood pressure. Your heart won’t have to work as hard and your blood will flow more easily through your blood vessels.

Central alpha agonists/central-acting agents include:

  • Clonidine hydrochloride (Catapres)
  • Clonidine hydrochloride and chlorthalidone (Clorpres, Combipres)
  • Guanabenz acetate
  • Guanfacine hydrochloride (Tenex)
  • Methyldopa and chlorothiazide (Aldochlor)
  • Methyldopa and hydrochlorothiazide

What to Expect When You Take Blood Pressure Drugs

Before you begin any medications, tell your doctor about all drugs, vitamins, and supplements that you’re on. You should be aware of any side effects and if there are any dangerous interactions with each type of drug.

Diuretics. The common side effects of these drugs, depending on which one you are on, are muscle cramps, weakness, rash, sensitivity to sunlight, cramps, vomiting, diarrhea, lightheadedness, or pain in your joints. You might also notice less common side effects like erectile dysfunction or an irregular heartbeat.

These symptoms can be similar to the side effects from lupus. If you notice new side effects, talk to your doctor. It’s important that you don’t stop these medications unless your health care team suggests you do so. Many of these drugs could affect your kidney function. If you stop them without your doctor’s approval, it could cause problems.

Be careful of interactions with drugs such as digitalis and digoxin (especially if you have a low potassium level) and certain antidepressants.

ACE inhibitors. Some of these drugs can make the amount of lithium in your blood go up, which could lead to side effects.

Other possible side effects include a cough, higher blood potassium levels, low blood pressure, constipation, dizziness, headache, sleepiness, weakness, a metallic or salty taste, or a rash. Less common ones could include kidney failure, allergic reactions, a lower white blood cell count, and angioedema (swelling in the tissue right under your skin).

People who are pregnant or could become pregnant should avoid ACE inhibitors. These drugs can cause birth defects.

Talk to your doctor if you take potassium supplements, salt supplements, or other medications that could change the amount of potassium in your body. ACE inhibitors could affect how much potassium is in your blood.

ARBs. Most people’s bodies can handle these drugs without any issues. But there still are some possible side effects. Common ones could include low blood pressure, a higher blood potassium level, dizziness, headaches, sleepiness, weakness, a metallic or salty taste, or a rash. You might also notice a cough.

You could also have more severe side effects, but they’re rare. These could include kidney or liver failure, allergic reactions, a lower white blood cell count, or angioedema.

Just like with ACE inhibitors, if you are pregnant or plan to become pregnant, you shouldn’t take these medications because they may lead to birth defects.

ARBs can cause you to have higher potassium levels in your body. Tell your doctor if you’re on potassium supplements, salt substitutes, or any other drugs that can affect how much potassium is in your blood. ARBs could also cause there to be a higher concentration of lithium in your blood. This could lead to more side effects.

Beta-blockers. Common side effects with these drugs include sleepiness, weakness, dizziness, and dry mouth, skin, and eyes. You may also notice cold hands and feet when on beta-blockers, especially if you have Raynaud’s syndrome with your lupus.

Other less common side effects could include difficulty sleeping, more lifelike dreams, wheezing, shortness of breath, a slow heartbeat, or swelling in your hands and feet.

Rare side effects with beta-blockers include erectile dysfunction, stomach cramps, diarrhea, vomiting, constipation, a rash, pain in your back or joints, a sore throat, depression, confusion, or memory loss. It’s important to call your doctor right away if you notice any of these symptoms.

Don’t drink alcohol while on beta-blockers. It could affect how well the medications work. Stay away from caffeine, over-the-counter cough and cold medicines, antihistamines, and antacids that have aluminum in them. Also, avoid grapefruits and grapefruit juice while on these medicines, as they can mess with the drugs. Tell your doctor about any blood pressure drugs, antidepressants, diabetes and asthma medications, or allergy shots you’ve had.

If you’re pregnant or think you could become pregnant, talk to your doctor before you start these drugs. You should only use them during pregnancy if it’s absolutely necessary.

Calcium channel blockers. You may notice nausea, constipation, a headache, rash, low blood pressure, drowsiness, dizziness, or edema (which is swelling due to fluid in your legs) while using these drugs.

Don’t take diltiazem or verapamil if you have heart failure. These drugs can lower your heart’s ability to pump blood. Tell your doctor about any heart or blood pressure medications and anti-seizure drugs that you’re on. Let them know if you take cyclosporine as well.

Don’t eat grapefruit or drink grapefruit juice while on calcium channel blockers. This food could increase some effects of these drugs. You should also stay away from alcohol because it messes with the effects of these medications and could potentially make the side effects worse.

Experts haven’t found any pregnancy or birth issues in people who take these drugs. But you should always talk to your doctor if you’re pregnant and start a new medication.

Diltiazem and verapamil will interact with a lot of other drugs that you’re on because they slow down the elimination process of some medications from your liver. Talk to your doctor about which drugs will interact with these types of calcium channel blockers. Some include:

  • Atorvastatin (Lipitor)
  • Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
  • Lovastatin (Altoprev, Mevacor)
  • Simvastatin (Flolipid, Zocor)

Your liver can’t get rid of these medications as efficiently. Because of this, they could build up in your blood and become toxic to your body.

Alpha-blockers. After you take these drugs for the first time, you may have a “first dose” effect. This can lead to dizziness (which can cause you to faint), more intense low blood pressure, orthostatic hypotension, or postural hypotension. To avoid these, get up slowly when you stand up.

Other side effects from alpha-blockers may include a pounding heartbeat, a headache, nausea, weight gain, weakness, or slightly higher LDL cholesterol levels.

Tell your doctor if you’re on any blood pressure medications, NSAIDs, erectile dysfunction therapy agents, immunosuppressives, antifungals, antibiotics, HIV medications, antidepressant or antianxiety drugs, asthma medications, or diabetic drugs.

Avoid diet pills, over-the-counter cough medicines, caffeine, and antihistamines while you’re on alpha-blockers. Limit your alcohol use. Don’t eat any grapefruit products because they interact with your liver’s ability to rid some substances. These substances could build up and become toxic.

If you’re pregnant or might become pregnant, talk to your doctor first before you start alpha blockers.

Central alpha agonists/central-acting agents. These drugs aren’t that popular because they have strong side effects. You may notice drowsiness, intense sleepiness, dizziness, erectile dysfunction, headaches, constipation, dry mouth, weight gain, trouble thinking, or psychological issues like depression.

If you notice these side effects, tell your doctor. But don’t stop the medication unless they say so. If you end treatment too fast, it could cause a sudden, harmful rise in blood pressure.

Show Sources

SOURCES:

Johns Hopkins Medicine: “Blood Pressure Medications (Anti-hypertensives),” “How Does Lupus Affect the Cardiovascular System,” “Treating Lupus with Immunosuppressive Medications.”

Lupus Foundation of America: “Are blood pressure medications safe for people with lupus?”

Hospital for Special Surgery: “Top 10 Series: Lupus and Cardiovascular Disease (CVD).”

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