16
Diagnosis
Table 10. Frequently Used Medications and Other
Substances That May Cause Elevated BP
(List is not all inclusive)
Agent Possible Management Strategy
Alcohol • Limit alcohol to ≤1 drink daily for women and
≤2 drinks for men
Amphetamines
(e.g., amphetamine,
methylphenidate
dexmethylphenidate,
dextroamphetamine)
• Discontinue or decrease dose
• Consider behavioral therapies for attention-deficit/
hyperactivity disorder (ADHD)
Antidepressants
(e.g., monoamine-oxidase
inhibitors [MAOIs],
serotonin norepinephrine
reuptake inhibitors [SNRIs],
tricyclic antidepressants
[TCAs])
• Consider alternative agents (e.g., selective serotonin
reuptake inhibitor [SSRIs]) depending on indication
• Avoid tyramine-containing foods with MAOIs
Atypical antipsychotics
(e.g., clozapine, olanzapine)
• Discontinue or limit use when possible
• Consider behavior therapy where appropriate
• Recommend lifestyle modification
(see Nonpharmacological Interventions)
• Consider alternative agents associated with lower
risk of weight gain, diabetes mellitus, and
dyslipidemia (e.g., aripiprazole, ziprasidone)
Caffeine • Generally limit caffeine intake to <300 mg/d
• Avoid use in patients with uncontrolled hypertension
• Coffee use in patients with hypertension is associated
with acute increases in BP; long-term use is not
associated with increased BP or CVD
Decongestants
(e.g., phenylephrine,
pseudoephedrine)
• Use for shortest duration possible, and avoid in severe
or uncontrolled hypertension
• Consider alternative therapies (e.g., nasal saline,
intranasal corticosteroids, antihistamines) as
appropriate
Herbal supplements
(e.g., Ma Huang [ephedra],
St. John's wort [with MAO
inhibitors, yohimbine])
• Avoid use
Immunosuppressants
(e.g., cyclosporine)
• Consider converting to tacrolimus, which may be
associated with fewer effects on BP
