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A countless variety of therapeutic agents (prescription medications and over-the-counter drugs) or chemical substances can increase blood pressure.

Non-prescription drugs or chemical substances that increase blood pressure:

1- Arthritis/pain medications: Motrin, ibuprofen, Advil, Aleve and aspirin. High doses of aspirin increases blood pressure. These medications increase salt and water retention causing edema (swelling).

2- Decongestants: pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE).

3- Caffeine: may increase BP levels. Caffeine in 2-3 cups of coffee can acutely raise BP by as much as 10 mm Hg in patients who are infrequently exposed to it.

4- Alcohol: excessive alcohol use has clearly been shown to raise BP and also can cause resistance to antihypertensive therapy. 

5- Herbal Products: some popular herbal products have the potential to increase BP and to interfere with antihypertensive treatment. Dietary supplements that 
contain ephedra alkaloids or ginkgo can increase BP. Some herbs can interfere with absorption of concurrently administered drugs.

6- Recreational drugs use (cocaine and Methamphetamine and phenethylamines, with a variety of stimulants) is associated with Acute severe hypertension that may require treatment with specific intravenous antihypertensive drugs.

7- Licorice induced hypertension, licorice is over 50 times sweeter than sugar. Daily consumption of 50 g or more of licorice candy for as little as two weeks may increase blood pressure. Licorice can cause potassium levels in the body to fall, triggering abnormal heart rhythms, edema (swelling), lethargy, and congestive heart failure in some people. After stopping licorice ingestion, It takes a week 
for the blood pressure and potassium to go back to normal.

8- Nicotine: Tobacco smoking, electronic cigarette use may raise blood pressure and increase the heart rate. The rise in blood pressure with each cigarette is transient. It lasts 30 minutes. Hence, no smoking for 30 minutes is required before blood pressure measurement.


Prescription drugs (commonly prescribed medications) that increase blood pressure: 

1- Sex Hormones
Oral contraceptives induce Hypertension in 5% of users of combined high-dose compounds that contain at least 50 μg of estrogen and 1-4 mg of progestin. No significant association between Hypertension and use of progesterone-only pills has been found.

Testosterone can cause severe hypertension due to increase angiotensin (a substance causes blood vessels constriction and salt retention) production by the liver.

2- Steroids (cortisol, prednisone)
Hypertension occurs in at least 20% of patients treated with steroids in a dose-dependent fashion; oral cortisol at doses of 80-200 mg/day can increase systolic BP as much as 15 mm Hg within 24 hours. At low doses, cortisol has less effect on blood pressure.

3- Antidepressant Agents
Venlafaxine hydrochloride(Effexor) is well known to cause elevation in blood pressure. Several others antidepressants can raise blood pressure especially at the higher doses.

4- Anti-HIV Treatment
Highly active antiretroviral therapy (HAART) can increase systolic BP. HAART does not usually increase BP before 6 months of use. The reaction to HAART is more 
pronounced in the elderly and in those with higher baseline systolic BP.


Prescription drugs (less commonly prescribed medications-specialty 
medications ) that increase blood pressure: 

1- Erythropoietin(Procrit)
Erythropoietin is effective in correcting the anemia of patients with chronic kidney disease and patients with malignancies. Hypertension develop, or to worsen, in 
20%-30% of patients treated with erythropoietin, and it may appear as early as 2 weeks and as late as 4 months after the start of treatment. 

2- Immunosuppressive Agents
These medications are used in transplant patients. cyclosporine-associated hypertension after transplantation varies in different studies between 50% and as high as 100%.

3- Cancer medications 
Certain drugs used for the treatment of various malignancies can increase blood pressure especially among the most recent ones like (VEGF).

The above mentioned drugs or chemicals that can raise blood pressure or make anti hypertension medications less effective are just examples of countless agents that can cause hypertension. 

Physician has to be knowledgeable and careful when evaluating the patient's drug regimen and he or she should be able to identify chemically induced hypertension and remove unnecessary evaluation and facilitate 
antihypertensive therapy. 

Once chemical-induced hypertension has been identified, discontinuation of the causative agent is recommended, although hypertension can often be managed by specific therapy and dose adjustment if continued use of the 
offending agent is mandatory.

Ghayas Habach M.D., M.P.H.

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