Drug induced resistant hypertension does happen.  It is important to recognize medications that can contribute to this as well as recognize when patients are on higher doses of this medications that may elevate blood pressure.  Here’s the scenario:

62 y/o female

Past medical history:

• CHF
• HTN
• GERD
• OA
• Neuropathy

Recent BP = 168/78

Medication list:

• Lasix 20 mg daily
• Celebrex 200 mg BID
• Lisinopril 40 mg daily
• Amlodipine 10 mg daily
• Effexor XR 300 mg daily
• Metoprolol tartrate 100 mg BID
• Ibuprofen 400 mg prn
• Omeprazole 20 mg daily
• Aspirin 81 mg daily
• Lipitor 10 mg daily

In regards to the resistant hypertension, I would certainly be looking at the duplication in using celecoxib and ibuprofen.  Assessment of the prn dose of ibuprofen and how much they are using it would be important.  A thorough work up of pain and identification of medications tried in the past would be important.  If hasn’t tried acetaminophen, that would be an option as well as topicals if the OA is localized.  If neuropathic pain is more problematic, certainly we could look further at some of the antiseizure (but would need to be careful with pregabalin and gabapentin with potential to impact CHF) medications.

The other medication that I would be looking at in regards to possible drug induced resistant hypertension would be the venlafaxine.  While at lower doses, this medication does not tend to contribute to this problem, higher doses can possibly contribute to hypertension.  Timing is always important in these scenarios as well.  If this had been added/increased recently that would lead me even more down the path of trying to reduce this medication.

What else would you like to investigate further?

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