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Sarah J. Wang Gary E Sander, MD, PhD


A number of both prescription and over the counter drugs, herbal supplements, and miscellaneous substances can increase blood pressure in subjects by degrees that vary substantially within drug classes and individual patients; such increases often remain within the normal range but may cause overt hypertension (BP>140/90) mmHg and even precipitate hypertensive crises. Blood pressure increases are often potentiated by co-existing cardiovascular conditions, age, renal disease, diabetes, obesity, and interactions with other concomitant medications. The need to scrutinize for drugs or other substances that may be contributing to elevated blood pressures or impairing responses to anti-hypertensive medications is critically important, particularly in the evaluation of resistant and refractory hypertension. Anti-hypertensive effects of diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers may be blunted. The drugs most commonly associated with blood pressure elevations are non-steroidal anti-inflammatory agents, sympathomimetic amines, estrogen-containing oral contraceptives, certain antidepressants, angiogenesis inhibitors, and ephedra. Although most drug-induced blood pressure increases do not, in fact, lead to overt hypertension, systolic and diastolic blood pressure elevations of as little as 2 mmHg lead to significant increases in the risk of cardiovascular events. When a medication with the potential to increase blood pressure is added to a patient’s therapeutic regimen, it is most important to monitor for possible changes in blood pressure even within the normal range. An initial diagnosis of hypertension should not be made until a thorough examination of all over the counter products and herbal substances that a patient may be consuming.

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WANG, Sarah J.; SANDER, Gary E. BLOOD PRESSURE INCREASES INDUCED BY IATROGENESIS, OVER THE COUNTER SUBSTANCES, AND HERBALS PRODUCTS. Medical Research Archives, [S.l.], v. 9, n. 5, may 2021. ISSN 2375-1924. Available at: <>. Date accessed: 28 feb. 2024. doi:
Research Articles


1. Gussak IB and Kostis JB. The concept of Iatrogenicity.. In Iatrogenesis. (ed I B Gussak and J B Kostis) RUPMNN-.
2. Giles TD SG, Fernandez C. . Iatrogenicity of Blood Pressure measurement in the Diagnosis of Hypertension. Rutgers University Press Medicine. 2018(2018):889-100.
3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-52.
4. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117(25):e510-26.
5. Wright JT, Jr., Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-16.
6. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-13.
7. Vasan RS, Larson MG, Leip EP, Evans JC, O'Donnell CJ, Kannel WB, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291-7.
8. Johnson AG, Nguyen TV, Day RO. Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis. Ann Intern Med. 1994;121(4):289-300.
9. Chan CC, Reid CM, Aw TJ, Liew D, Haas SJ, Krum H. Do COX-2 inhibitors raise blood pressure more than nonselective NSAIDs and placebo? An updated meta-analysis. J Hypertens. 2009;27(12):2332-41.
10. Whelton A, White WB, Bello AE, Puma JA, Fort JG. Effects of celecoxib and rofecoxib on blood pressure and edema in patients > or =65 years of age with systemic hypertension and osteoarthritis. Am J Cardiol. 2002;90(9):959-63.
11. Bresalier RS, Sandler RS, Quan H, Bolognese JA, Oxenius B, Horgan K, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med. 2005;352(11):1092-102.
12. Radack KL, Deck CC, Bloomfield SS. Ibuprofen interferes with the efficacy of antihypertensive drugs. A randomized, double-blind, placebo-controlled trial of ibuprofen compared with acetaminophen. Ann Intern Med. 1987;107(5):628-35.
13. Muscará MN, Vergnolle N, Lovren F, Triggle CR, Elliott SN, Asfaha S, et al. Selective cyclo-oxygenase-2 inhibition with celecoxib elevates blood pressure and promotes leukocyte adherence. Br J Pharmacol. 2000;129(7):1423-30.
14. Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769-79.
15. Conlin PR, Moore TJ, Swartz SL, Barr E, Gazdick L, Fletcher C, et al. Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension. 2000;36(3):461-5.
16. White WB, Kent J, Taylor A, Verburg KM, Lefkowith JB, Whelton A. Effects of celecoxib on ambulatory blood pressure in hypertensive patients on ACE inhibitors. Hypertension. 2002;39(4):929-34.
17. Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. Arch Intern Med. 2005;165(15):1686-94.
18. Salerno SM, Jackson JL, Berbano EP. The impact of oral phenylpropanolamine on blood pressure: a meta-analysis and review of the literature. J Hum Hypertens. 2005;19(8):643-52.
19. King A, Dimovska M, Bisoski L. Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension. Curr Hypertens Rep. 2018;20(1):8.
20. Taneja I, Diedrich A, Black BK, Byrne DW, Paranjape SY, Robertson D. Modafinil elicits sympathomedullary activation. Hypertension. 2005;45(4):612-8.
21. Jordan J, Scholze J, Matiba B, Wirth A, Hauner H, Sharma AM. Influence of Sibutramine on blood pressure: evidence from placebo-controlled trials. Int J Obes (Lond). 2005;29(5):509-16.
22. Chasan-Taber L, Willett WC, Manson JE, Spiegelman D, Hunter DJ, Curhan G, et al. Prospective study of oral contraceptives and hypertension among women in the United States. Circulation. 1996;94(3):483-9.
23. Cardoso F, Polónia J, Santos A, Silva-Carvalho J, Ferreira-de-Almeida J. Low-dose oral contraceptives and 24-hour ambulatory blood pressure. Int J Gynaecol Obstet. 1997;59(3):237-43.
24. Narkiewicz K, Graniero GR, D'Este D, Mattarei M, Zonzin P, Palatini P. Ambulatory blood pressure in mild hypertensive women taking oral contraceptives. A case-control study. Am J Hypertens. 1995;8(3):249-53.
25. Shufelt CL, Bairey Merz CN. Contraceptive hormone use and cardiovascular disease. J Am Coll Cardiol. 2009;53(3):221-31.
26. Palatini P, Giada F, Garavelli G, Sinisi F, Mario L, Michieletto M, et al. Cardiovascular effects of anabolic steroids in weight-trained subjects. J Clin Pharmacol. 1996;36(12):1132-40.
27. D'Andrea A, Caso P, Salerno G, Scarafile R, De Corato G, Mita C, et al. Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis. Br J Sports Med. 2007;41(3):149-55.
28. Lenders JW, Demacker PN, Vos JA, Jansen PL, Hoitsma AJ, van 't Laar A, et al. Deleterious effects of anabolic steroids on serum lipoproteins, blood pressure, and liver function in amateur body builders. Int J Sports Med. 1988;9(1):19-23.
29. Liu JD, Wu YQ. Anabolic-androgenic steroids and cardiovascular risk. Chin Med J (Engl). 2019;132(18):2229-36.
30. Grace F, Sculthorpe N, Baker J, Davies B. Blood pressure and rate pressure product response in males using high-dose anabolic androgenic steroids (AAS). J Sci Med Sport. 2003;6(3):307-12.
31. Vora CK, Mansoor GA. Herbs and alternative therapies: relevance to hypertension and cardiovascular diseases. Curr Hypertens Rep. 2005;7(4):275-80.
32. Miyashita K, Tojo A, Kimura K, Goto A, Omata M, Nishiyama K, et al. Blood pressure response to erythropoietin injection in hemodialysis and predialysis patients. Hypertens Res. 2004;27(2):79-84.
33. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med. 2000;343(25):1833-8.
34. Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med. 2002;136(1):42-53.
35. Mansoor GA. Herbs and alternative therapies in the hypertension clinic. Am J Hypertens. 2001;14(9 Pt 1):971-5.
36. Walker BR, Edwards CR. Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess. Endocrinol Metab Clin North Am. 1994;23(2):359-77.
37. Blom WA, Abrahamse SL, Bradford R, Duchateau GS, Theis W, Orsi A, et al. Effects of 15-d repeated consumption of Hoodia gordonii purified extract on safety, ad libitum energy intake, and body weight in healthy, overweight women: a randomized controlled trial. Am J Clin Nutr. 2011;94(5):1171-81.
38. Jalili J, Askeroglu U, Alleyne B, Guyuron B. Herbal products that may contribute to hypertension. Plast Reconstr Surg. 2013;131(1):168-73.
39. Licht CM, de Geus EJ, Seldenrijk A, van Hout HP, Zitman FG, van Dyck R, et al. Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension. 2009;53(4):631-8.
40. Niu G, Chen X. Vascular endothelial growth factor as an anti-angiogenic target for cancer therapy. Curr Drug Targets. 2010;11(8):1000-17.
41. Wu S, Chen JJ, Kudelka A, Lu J, Zhu X. Incidence and risk of hypertension with sorafenib in patients with cancer: a systematic review and meta-analysis. Lancet Oncol. 2008;9(2):117-23.
42. Zhu X, Stergiopoulos K, Wu S. Risk of hypertension and renal dysfunction with an angiogenesis inhibitor sunitinib: systematic review and meta-analysis. Acta Oncol. 2009;48(1):9-17.
43. An MM, Zou Z, Shen H, Liu P, Chen ML, Cao YB, et al. Incidence and risk of significantly raised blood pressure in cancer patients treated with bevacizumab: an updated meta-analysis. Eur J Clin Pharmacol. 2010;66(8):813-21.
44. de Jesus-Gonzalez N, Robinson E, Moslehi J, Humphreys BD. Management of antiangiogenic therapy-induced hypertension. Hypertension. 2012;60(3):607-15.
45. Robinson ES, Matulonis UA, Ivy P, Berlin ST, Tyburski K, Penson RT, et al. Rapid development of hypertension and proteinuria with cediranib, an oral vascular endothelial growth factor receptor inhibitor. Clin J Am Soc Nephrol. 2010;5(3):477-83.
46. Bae S, Hong YC. Exposure to bisphenol A from drinking canned beverages increases blood pressure: randomized crossover trial. Hypertension. 2015;65(2):313-9.
47. Lian C. L'alcoholisme cdhaBANMP-.
48. MacMahon S. Alcohol consumption and hypertension. Hypertension. 1987;9(2):111-21.
49. McFadden CB, Brensinger CM, Berlin JA, Townsend RR. Systematic review of the effect of daily alcohol intake on blood pressure. Am J Hypertens. 2005;18(2 Pt 1):276-86.
50. Marchi KC, Muniz JJ, Tirapelli CR. Hypertension and chronic ethanol consumption: What do we know after a century of study? World J Cardiol. 2014;6(5):283-94.
51. Jackson R, Stewart A, Beaglehole R, Scragg R. Alcohol consumption and blood pressure. Am J Epidemiol. 1985;122(6):1037-44.
52. Harlan WR, Landis JR, Schmouder RL, Goldstein NG, Harlan LC. Blood lead and blood pressure. Relationship in the adolescent and adult US population. Jama. 1985;253(4):530-4.
53. Harlan WR. The relationship of blood lead levels to blood pressure in the U.S. population. Environ Health Perspect. 1988;78:9-13.
54. Vupputuri S, He J, Muntner P, Bazzano LA, Whelton PK, Batuman V. Blood lead level is associated with elevated blood pressure in blacks. Hypertension. 2003;41(3):463-8.
55. Cheng Y, Schwartz J, Sparrow D, Aro A, Weiss ST, Hu H. Bone lead and blood lead levels in relation to baseline blood pressure and the prospective development of hypertension: the Normative Aging Study. Am J Epidemiol. 2001;153(2):164-71.