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Hypertension in the Setting of Hypertrophic Obstructive Cardiomyopathy and Cocaine Use

Daniel Miller1, Asma Hosna1, Sanna Salam1

  • 1Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA.

Cureus
|November 16, 2022
PubMed

Insights

Hypertrophic obstructive cardiomyopathy (HOCM) management is complex, especially with cocaine use. Beta-blockers are risky due to unopposed alpha effects, necessitating careful treatment selection and patient education on avoiding illicit substances.

Area of Science:

  • Cardiology
  • Pharmacology
  • Genetics

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is a primary genetic heart condition.
  • Hypertension management in HOCM is complicated by medication restrictions, favoring beta-adrenergic receptor antagonists.
  • Agents reducing preload or afterload are generally contraindicated in HOCM.

Observation:

  • Cocaine use presents a significant challenge in HOCM patients.
  • Beta-adrenergic receptor antagonists are risky in cocaine users due to unopposed alpha-adrenergic stimulation, potentially worsening hypertension.
  • Cocaine's inherent hypertensive and vasoconstrictive effects complicate treatment further.

Findings:

  • Non-dihydropyridine calcium channel blockers are the remaining therapeutic option.
  • These calcium channel blockers may be insufficient to counteract cocaine's vasoconstrictive effects.
  • Patients with HOCM and a history of cocaine use require specialized management strategies.

Implications:

  • Strict avoidance of cocaine is paramount for HOCM patients.
  • Enhanced patient education regarding the risks of cocaine use in HOCM is crucial.
  • Further research into safe and effective antihypertensive strategies for HOCM patients with substance use is warranted.

Keywords:
cocaine usehypertensionhypertensive urgencyhypertrophic obstructive cardiomyopathy (hocm)pharmacology

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