Drug-induced hypertension. Recognition and management in older patients

This article reviews the potential of a number of drug classes to produce or aggravate hypertension, with particular emphasis on older patients. Although little information is available regarding the hypertensive effects of mineralocorticoids in the elderly, glucocorticoids usually induce an increase in blood pressure (BP) that is dosage-dependent. Nonsteroidal anti-inflammatory drugs occasionally increase BP, but this effect is not usually clinically relevant. The alleged hypertensive potential of oral antihyperglycaemic agents has not yet been substantiated. In contrast, some antidepressants may be particularly dangerous in terms of their hypertensive complications. Although hypertension may be induced by monoamine oxidase inhibitors (MAOIs) given as monotherapy, severe hypertension is more likely to occur when MAOIs are combined with other sympathomimetic drugs. Several other drugs may also increase the risk of hypertension in elderly patients, but reliable data are lacking for most of these agents. Elderly people who are being treated with drugs that may increase BP should be closely monitored. This is particularly true for drugs that act on the CNS.