Common Substances That May Contribute to Resistant Hypertension, and Recommendations for Limiting Their Clinical Effects

Abstract

Purpose of review: The purpose of this review is to highlight common or important substances or habits that elevate blood pressure and offer suggestions, based on recent literature, to limit their use or effects.

Recent findings: Despite decades of advice to the general populace from public health authorities to avoid or reduce dietary sodium and non-steroidal anti-inflammatory drug (NSAID) use, more evidence has accumulated from nationwide surveys, clinical trials, and pathophysiological or mechanistic studies that show how important these modalities can (and should) be for hypertensive and prehypertensive individuals and the general population. Other common stimuli that increase blood pressure can be divided into many that are easily avoided (e.g., phenethylamines, anabolic steroids), those that must be continued for important medical reasons (e.g., erythropoietin, tyrosine kinase inhibitors) and therefore require intensified antihypertensive therapy, and a few (e.g., glucocorticoids, hormonal contraceptives) that fall between these two paradigms.

Keywords: Blood pressure; Drug-induced hypertension; Resistant hypertension; Secondary hypertension.