Developing practical recommendations for drug-disease interactions in patients with hypertension

Area of Science:

• Pharmacology
• Cardiology
• Clinical Practice

Background:

• Hypertension is a major risk factor for cardiovascular diseases (CVD), the leading cause of global mortality.
• Effective blood pressure management (<140/90 mmHg) significantly reduces CVD and all-cause mortality risks.
• Comorbidities and their medications can complicate hypertension treatment through drug-disease interactions (DDSI).

Purpose of the Study:

• To assess the safety of medications affecting blood pressure in hypertensive patients.
• To develop practical recommendations for healthcare professionals regarding DDSI in hypertension.
• To identify specific drugs that cause clinically relevant drug-disease interactions with hypertension.

Main Methods:

• A six-step plan combining literature review and multidisciplinary expert consensus was employed.
• Defined clinically relevant blood pressure changes as >=10 mmHg systolic and >=5 mmHg diastolic.
• Evaluated drugs for clinically relevant DDSI with hypertension, considering official product information and clinical guidelines.

Main Results:

• Corticosteroids, danazol, and yohimbine were identified as causing clinically relevant DDSI with hypertension.
• Other drugs with hypertension warnings showed no clinically relevant DDSI due to minor effects or insufficient data.
• Drugs with known blood pressure effects, managed under close monitoring, were deemed not clinically relevant for signalling.

Conclusions:

• Specific recommendations for DDSI in hypertension can be implemented in clinical practice, such as in decision support systems.
• Safer medication use in hypertensive patients can be achieved, reducing alert fatigue and improving healthcare.
• Future research should evaluate implementation strategies and their impact on reducing unsafe medication use.