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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 September 16, 2025 e137

Table 11.  Selected List of Frequently Used Medications and Other Substances That May Cause Elevated Blood Pressure With Recommendations for Management* Agent Possible Management Strategy Nonprescription drugs/substance Alcohol Options include abstinence or limit alcohol to ≤1 drink daily for women and ≤2 drinks daily for men26,27 Caffeine28 Limit caffeine intake to <300 mg/d

Avoid more than 1 cup daily in patients with severe uncontrolled hypertension

Decongestants (eg, phenylephrine, pseudoephedrine) Use for shortest duration possible and avoid in severe or uncontrolled hypertension

Consider alternative therapies (eg, nasal saline, intranasal corticosteroids, antihista­ mines) as appropriate

Herbal supplements (eg, Ma Huang, ephedra, St. John’s wort [with MAO inhibitors, yohimbine]) Avoid use Black licorice29 Avoid use NSAIDs; acetaminophen Avoid systemic NSAIDs when possible

Limit acetaminophen to less than 4 g/d12 Consider alternative analgesics (eg, topical NSAIDs), depending on indication and risk

Recreational drugs (eg, “bath salts” [MDPV], cocaine, methamphetamine, etc) Discontinue or avoid use Prescription drugs Sudden withdrawal of central-acting sympatholytic drugs such as clonidine and tizanidine Recommend avoiding oral clonidine for treatment of hypertension whenever possible and tapering upon discontinuation30; use cyclobenzaprine or other muscle relaxants instead of tizanidine31 Amphetamines† (eg, amphetamine, methylphenidate dexmethylphenidate, dexamfet­ amine, lisdexamfetamine, dextroamphetamine) Discontinue or decrease dose

Consider behavioral therapies or nonstimulants (such as guanfacine) for ADHD32

Antidepressants† (eg, MAOIs, SNRIs, TCAs) Consider alternative agents (eg, SSRIs) depending on indication

Avoid tyramine-containing foods with MAOIs

Atypical antipsychotics† (eg, risperidone, olanzapine)33,34 Discontinue or limit use when possible

Consider behavior therapy where appropriate Recommend lifestyle modification (Section 5.1 “Lifestyle and Psychosocial Ap­ proaches”) Consider alternative agents associated with lower risk of weight gain, diabetes, and dyslipidemia

Immunosuppressants† (eg, cyclosporine) Consider converting to tacrolimus, which may be associated with fewer effects on BP Oral contraceptives† Use low-dose (eg, 20-30 mcg ethinyl estradiol) agents or a progestin-only form of contraception, or consider alternative forms of birth control where appropriate (eg, barrier, abstinence, nonhormonal IUD)

Avoid use in women with uncontrolled hypertension35

Systemic corticosteroids† (eg, dexamethasone, fludrocortisone, methylprednisolone, prednisone, prednisolone) Avoid or limit use when possible

Consider alternative modes of administration (eg, inhaled, topical) when feasible

Angiogenesis inhibitor† (eg, bevacizumab) and tyrosine kinase inhibitors (eg, sunitinib, sorafenib) Avoid or limit use when possible Androgen deprivation therapy† such as CYP 17 inhibitors (eg, abiraterone, orteronel) or andro­ gen receptor antagonist (eg, enzalutamide)36 Avoid or limit use when possible

Consider alternative chemotherapy

*List is not all inclusive. †In specific cases when a specific therapy is needed or the best option for the patient, it is reasonable to continue the medication and initiate or intensify antihypertensive therapy. Modified with permission from Whelton et al.14 Copyright 2018 American College of Cardiology Foundation and American Heart Association, Inc. ADHD indicates attention-deficit/hyperactivity disorder; BP, blood pressure; CVD, cardiovascular disease; IUD, intrauterine device; MAOI, monoamine-oxidase inhibitors; MDPV, methylenedioxy pyrovalerone; NSAIDs, nonsteroidal anti-inflammatory drugs; SNRI, serotonin norepinephrine-reuptake inhibitor; SSRI, selective serotonin-reuptake inhibitor; and TCA, tricyclic antidepressant.

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