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  • Most people with hypertension in the United States have not managed to lower their blood pressure to recommended levels with treatment.
  • There are many causes of high blood pressure, and some drugs can contribute to this.
  • Researchers have shown that many individuals with hypertension are taking medications that could raise their blood pressure.
  • There are often alternatives to these drugs that healthcare professionals should consider for those individuals.

Nearly half of adults in the U.S. have high blood pressure, or hypertension. Yet only 1 in 4 of them have managed to reduce their blood pressure to the recommended levels with treatment, according to the Centers for Disease Control and Prevention (CDC).

It is important to keep blood pressure within the recommended levels of under 120/80 millimeters of mercury (mm Hg). Hypertension increases the risk of developing a heart attack and stroke, which are leading causes of death in the U.S.

The causes of high blood pressure vary, with genetics, diet, exercise, lifestyle, aldara acné and some medical conditions all playing a role. Certain medications for a number of different conditions can also raise blood pressure.

Researchers from Beth Israel Deaconess Medical Center in Boston, a Harvard-affiliated teaching hospital, have examined existing survey data to determine how many people with hypertension are taking medication that may raise blood pressure.

Their results appear in a research letter in the journal JAMA Internal Medicine.

Letter co-author Dr. Timothy Anderson spoke with Medical News Today. He explained that sometimes, there is no choice but to give some people with hypertension drugs that can raise their blood pressure; however, other times, there may be other options:

“In some cases, these medications are appropriate, as they are treating an important issue without a better alternative. However, in many cases, I think the risk of raising blood pressure is simply overlooked, particularly for patients using these medications for many years.”

Analyzing survey data

The researchers analyzed data from the National Health and Nutrition Examination Survey collected between 2009 and 2018. The dataset consisted of information about people over the age of 18 who were not pregnant.

In total, there were 27,599 adults, of whom 11.3% were Black, 14.8% were Hispanic, and 65.3% were non-Hispanic white.

Data for the survey were generated by home interviews. Among other details, information about prescription medications was obtained.

The researchers identified antihypertensive medications, which people take for hypertension, and medications that may cause elevated blood pressure.

Hypertension was defined as systolic blood pressure of 130 mm Hg or higher, diastolic blood pressure of 80 mm Hg or higher, or if a person answered “yes” to the question, “Have you ever been told by a doctor or other healthcare professional that you had hypertension, also called high blood pressure?”

The prevalence of hypertension and uncontrolled hypertension was 49.2% and 35.4%, respectively.

While the researchers had expected to find that some of the individuals would be taking prescription medications that could raise blood pressure, they were surprised to find that there were so many.

Their analysis shows that nearly 1 in 5 adults in the United States with hypertension were on medication that could raise their blood pressure. The authors found that a total of 15% of all adults were on these medications.

Dr. Anderson told MNT: “It certainly is a higher proportion than I might have guessed starting out, though we see this scenario often in our primary care clinics. We also anticipate this is an understatement, as our study does not include over-the-counter [(OTC)] medications that were not prescribed, and many [OTC] medications, including anti-inflammatories and decongestants, may raise blood pressure.”

Increasing risk

The researchers also observed an association between these medications and increased risk of uncontrolled hypertension in people who were not receiving antihypertensives, but not among those who were receiving them.

They also found that “The use of medications that may raise [blood pressure] was associated with greater use of antihypertensives among both adults with controlled hypertension […] and adults with uncontrolled hypertension.”

The most commonly prescribed medications that cause a rise in blood pressure are antidepressants, nonsteroidal anti-inflammatory drugs, steroids, and estrogen.

MNT also spoke with Dr. Dave Dixon, an associate professor from the Virginia Commonwealth University School of Pharmacy, who was not involved in the study. He explained:

“This study further highlights the important role of pharmacists in helping to minimize the use of medications that may worsen hypertension. For example, not all antidepressants affect blood pressure the same, so pharmacists can recommend alternatives to the prescriber that have little to no effect on blood pressure to avoid unnecessary worsening of blood pressure control.”

Reducing or eliminating the use of some of the prescribed medications could cause different challenges, and Dr. Dixon pointed out it was unclear in the paper for how long the individuals were taking these medications.

He advised, “Regardless, patients with hypertension should monitor their blood pressure closely at home with a validated home blood pressure monitor and report changes to their [doctor].”

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