Vol 25, No 4 (2021)
Review paper
Published online: 2021-07-13

open access

Page views 6162
Article views/downloads 3627
Get Citation

Connect on Social Media

Connect on Social Media

The risk of a blood pressure increase during treatment with selected psychotropic drugs

Monika Romańczyk1, Stanisław Surma1, Beata Kocyan1, Karolina Kłos2, Wiktoria Strona1, Marek Krzystanek1
Arterial Hypertension 2021;25(4):135-144.


Arterial hypertension is the most common cardiovascular risk factor in the general population. Increased mortality from arterial hypertension affects all ethnicities and ages, including those with mental disorders. Most people with arterial hypertension suffer from the primary form of the disease. The aim of this article was to analyze the influence of psychiatric drugs on blood pressure.

The articles for analysis were selected via the PubMed search engine in the Medline database using the names of individual drugs or a group of psychotropic drugs, the AND operator and the words “hypertension” or “blood pressure” or “cardiovascular system”. The articles were then selected and 44 references were selected for analysis. Selected articles were archived on April 9, 2021. Many medications with the potential to increase blood pressure are used to treat mental illness. These include venlafaxine, milnacipran, bupropion, esketamine, 1st and 2nd generation antipsychotics, tricyclic antidepressants and psychostimulants.

In patients using psychotropic drugs that may increase blood pressure, attention should be paid to monitoring it during treatment.

Article available in PDF format

View PDF Download PDF file


  1. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. J Hypertension. 2018; 36(10): 1953–2041.
  2. Wang YR, Alexander GC, Stafford RS. Outpatient hypertension treatment, treatment intensification, and control in Western Europe and the United States. Arch Intern Med. 2007; 167(2): 141–147.
  3. Cutler JA, Sorlie PD, Wolz M, et al. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008; 52(5): 818–827.
  4. Surma St, Szyndler A, Narkiewicz K. Świadomość czynników ryzyka chorób układu sercowo-naczyniowego w populacji młodych osób. Choroby Serca i Naczyń. 2017; 14(4): 186–193.
  5. Surma St, Szyndler A, Narkiewicz K. Świadomość nadciśnienia tętniczego i innych czynników ryzyka chorób układu sercowo-naczyniowego w populacji osób dorosłych. Choroby Serca i Naczyń. 2018; 15(1): 14–22.
  6. Grossman A, Messerli FH, Grossman E. Drug induced hypertension--An unappreciated cause of secondary hypertension. Eur J Pharmacol. 2015; 763(Pt A): 15–22.
  7. Morreale MK, Wake LA. Psychiatric Medications and Hypertension. Curr Hypertens Rep. 2020; 22(11): 86.
  8. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159): 1789–1858.
  9. Olfson M, Marcus SC, Olfson M, et al. Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry. 2003; 60(10): 978–982.
  10. Moraczewski J, Aedma K. Tricyclic antidepressants. In: Moraczewski J, Aedma K. ed. StatPearls [Internet] . StatPearls Publishing, Treasure Island 2020: [Update 2020 Dec 7].
  11. Thase ME. Effects of venlafaxine on blood pressure: a meta-analysis of original data from 3744 depressed patients. J Clin Psychiatry. 1998; 59(10): 502–508.
  12. Licht CMM, de Geus EJC, Seldenrijk A, et al. Depression is associated with decreased blood pressure, but antidepressant use increases the risk for hypertension. Hypertension. 2009; 53(4): 631–638.
  13. Pimentel L, Trommer L. Cyclic antidepressant overdoses. A review. Emerg Med Clin North Am. 1994; 12(2): 533–547.
  14. Vaclavik J, Krenkova A, Kocianova E, et al. Effect of sertraline in paroxysmal hypertension. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018; 162(2): 116–120.
  15. Zhong Z, Wang L, Wen X, et al. A meta-analysis of effects of selective serotonin reuptake inhibitors on blood pressure in depression treatment: outcomes from placebo and serotonin and noradrenaline reuptake inhibitor controlled trials. Neuropsychiatr Dis Treat. 2017; 13: 2781–2796.
  16. Peixoto MF, Cesaretti M, Hood SD, et al. Effects of SSRI medication on heart rate and blood pressure in individuals with hypertension and depression. Clin Exp Hypertens. 2019; 41(5): 428–433.
  17. Humbert X, Fedrizzi S, Chrétien B, et al. Hypertension induced by serotonin reuptake inhibitors: analysis of two pharmacovigilance databases. Fundam Clin Pharmacol. 2019; 33(3): 296–302.
  18. Foy MC, Vaishnav J, Sperati CJ. Drug-Induced Hypertension. Endocrinol Metab Clin North Am. 2019; 48(4): 859–873.
  19. Park K, Kim S, Ko YJ, et al. Duloxetine and cardiovascular adverse events: A systematic review and meta-analysis. J Psychiatr Res. 2020; 124: 109–114.
  20. Derby MA, Zhang Lu, Chappell JC, et al. The effects of supratherapeutic doses of duloxetine on blood pressure and pulse rate. J Cardiovasc Pharmacol. 2007; 49(6): 384–393.
  21. Mease PJ, Clauw DJ, Gendreau RM, et al. The efficacy and safety of milnacipran for treatment of fibromyalgia. a randomized, double-blind, placebo-controlled trial. J Rheumatol. 2009; 36(2): 398–409.
  22. Trugman JM, Palmer RH, Ma Y. Milnacipran effects on 24-hour ambulatory blood pressure and heart rate in fibromyalgia patients: a randomized, placebo-controlled, dose-escalation study. Curr Med Res Opin. 2014; 30(4): 589–597.
  23. Gillman PK. A reassessment of the safety profile of monoamine oxidase inhibitors: elucidating tired old tyramine myths. J Neural Transm (Vienna). 2018; 125(11): 1707–1717.
  24. Hammerness P, Basch E, Ulbricht C, et al. Natural Standard Research Collaboration. St John's wort: a systematic review of adverse effects and drug interactions for the consultation psychiatrist. Psychosomatics. 2003; 44(4): 271–282.
  25. Patel S, Robinson R, Burk M. Hypertensive crisis associated with St. John's Wort. Am J Med. 2002; 112(6): 507–508.
  26. Myers A, Trivedi M. The Effect of Antidepressant Therapy on Blood Pressure and Heart Rate Variability. Psychopharm Rev. 2013; 48(1): 1–7.
  27. Fiedorowicz JG, Swartz KL. The role of monoamine oxidase inhibitors in current psychiatric practice. J Psychiatr Pract. 2004; 10(4): 239–248.
  28. Biaggioni I. Orthostatic Hypotension in the Hypertensive Patient. Am J Hypertens. 2018; 31(12): 1255–1259.
  29. Saiz-Rodríguez M, Belmonte C, Derqui-Fernández N, et al. Pharmacogenetics of trazodone in healthy volunteers: association with pharmacokinetics, pharmacodynamics and safety. Pharmacogenomics. 2017; 18(16): 1491–1502.
  30. Watanabe N, Omori IM, Nakagawa A, et al. MANGA (Meta-Analysis of New Generation Antidepressants) Study Group. Safety reporting and adverse-event profile of mirtazapine described in randomized controlled trials in comparison with other classes of antidepressants in the acute-phase treatment of adults with depression: systematic review and meta-analysis. CNS Drugs. 2010; 24(1): 35–53.
  31. Doherty T, Wajs E, Melkote R, et al. Cardiac Safety of Esketamine Nasal Spray in Treatment-Resistant Depression: Results from the Clinical Development Program. CNS Drugs. 2020; 34(3): 299–310.
  32. Thase ME, Haight BR, Johnson MC, et al. A randomized, double-blind, placebo-controlled study of the effect of sustained-release bupropion on blood pressure in individuals with mild untreated hypertension. J Clin Psychopharmacol. 2008; 28(3): 302–307.
  33. Roose SP, Dalack GW, Glassman AH, et al. Is doxepin a safer tricyclic for the heart? J Clin Psychiatry. 1991; 52(8): 338–341.
  34. Kiev A, Masco HL, Wenger TL, et al. The cardiovascular effects of bupropion and nortriptyline in depressed outpatients. Ann Clin Psychiatry. 1994; 6(2): 107–115.
  35. Teply RM, Packard KA, White ND, et al. Treatment of Depression in Patients with Concomitant Cardiac Disease. Prog Cardiovasc Dis. 2016; 58(5): 514–528.
  36. Zhang Y, Wang Q, Reynolds GP, et al. Chinese Antipsychotics Pharmacogenomics Consortium. Metabolic Effects of 7 Antipsychotics on Patients With Schizophrenia: A Short-Term, Randomized, Open-Label, Multicenter, Pharmacologic Trial. J Clin Psychiatry. 2020; 81(3).
  37. Nasrallah H. A review of the effect of atypical antipsychotics on weight. Psychoneuroendocrinology. 2003; 28: 83–96.
  38. Ko YK, Soh MA, Kang SH, et al. The prevalence of metabolic syndrome in schizophrenic patients using antipsychotics. Clin Psychopharmacol Neurosci. 2013; 11(2): 80–88.
  39. Gugger J. Antipsychotic Pharmacotherapy and Orthostatic Hypotension. CNS Drugs. 2011; 25(8): 659–671.
  40. Gonsai NH, Amin VH, Mendpara CG, et al. Effects of dopamine receptor antagonist antipsychotic therapy on blood pressure. J Clin Pharm Ther. 2018; 43(1): 1–7.
  41. Woo YS, Kim W, Chae JH, et al. Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients. World J Biol Psychiatry. 2009; 10(4 Pt 2): 420–425.
  42. Norman SM, Sullivan KM, Liu F, et al. Blood Pressure and Heart Rate Changes During Clozapine Treatment. Psychiatr Q. 2017; 88(3): 545–552.
  43. Tse L, Procyshyn RM, Fredrikson DH, et al. Pharmacological treatment of antipsychotic-induced dyslipidemia and hypertension. Int Clin Psychopharmacol. 2014; 29(3): 125–137.
  44. Handler J. Lithium and antihypertensive medication: a potentially dangerous interaction. J Clin Hypertens (Greenwich). 2009; 11(12): 738–742.
  45. Juurlink DN, Mamdani MM, Kopp A, et al. Drug-induced lithium toxicity in the elderly: a population-based study. J Am Geriatr Soc. 2004; 52(5): 794–798.
  46. Danielsson KC, Borthen I, Morken NH, et al. Hypertensive pregnancy complications in women with epilepsy and antiepileptic drugs: a population-based cohort study of first pregnancies in Norway. BMJ Open. 2018; 8(4): e020998.
  47. Katsiki N, Mikhailidis DP, Nair DR. The effects of antiepileptic drugs on vascular risk factors: a narrative review. Seizure. 2014; 23(9): 677–684.
  48. Wilens TE, Biederman J, Lerner M, et al. Concerta Study Group. Effects of once-daily osmotic-release methylphenidate on blood pressure and heart rate in children with attention-deficit/hyperactivity disorder: results from a one-year follow-up study. J Clin Psychopharmacol. 2004; 24(1): 36–41.
  49. Biederman J, Mick E, Surman C, et al. A randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2006; 59(9): 829–835.
  50. Weisler RH, Biederman J, Spencer TJ, et al. Long-term cardiovascular effects of mixed amphetamine salts extended release in adults with ADHD. CNS Spectr. 2005; 10(12 Suppl 20): 35–43.
  51. Adler LA, Weisler RH, Goodman DW, et al. Short-term effects of lisdexamfetamine dimesylate on cardiovascular parameters in a 4-week clinical trial in adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2009; 70(12): 1652–1661.
  52. Kratochvil CJ, Milton DR, Vaughan BS, et al. Acute atomoxetine treatment of younger and older children with ADHD: a meta-analysis of tolerability and efficacy. Child Adolesc Psychiatry Ment Health. 2008; 2(1): 25.
  53. Hennissen L, Bakker MJ, Banaschewski T, et al. ADDUCE consortium. Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine. CNS Drugs. 2017; 31(3): 199–215.
  54. Liang EF, Lim SZ, Tam WW, et al. The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression. Int J Environ Res Public Health. 2018; 15(8).
  55. Martinez-Raga J, Knecht C, Szerman N, et al. Risk of serious cardiovascular problems with medications for attention-deficit hyperactivity disorder. CNS Drugs. 2013; 27(1): 15–30.
  56. Grossman A, Messerli FH, Grossman E, et al. Drug-induced hypertension: an unappreciated cause of secondary hypertension. Am J Med. 2012; 125(1): 14–22.