ABSTRACT

The most common iatrogenic causes of truly sustained high blood pressure or unexplained resistance to antihypertensive drugs are sympathomimetic amines, monoamine oxidase inhibitors (MAOI), carbenoxolone, non-steroidal anti-inflammatory drugs (NSAID) and the contraceptive pill. Sympathomimetic amines usually cause psychiatric rather than cardiovascular symptoms, but forgotten use or unsuspected abuse of these drugs is an occasional cause of raised pressure, or of hypertension inexplicably resistant to treatment. MAOIs are effective antidepressant drugs, useful because they act more quickly than tricyclic or quadricyclic antidepressants, do not cause the troublesome anticholinergic side effects of tricyclics, and are less dangerous suicidal agents. Some NSAIDs, for example dipropazone, are effective for some patients despite low prostaglandin synthetase inhibitory activity and probably have less hypertensive effect. Prescription of oral contraceptives carries with it a duty to ensure that blood pressure is checked regularly. Hormone replacement therapy is a controversial subject when related to blood pressure.