Effect of Evening Bromazepam Administration on Blood Pressure and Heart Rate in Mild Hypertensive Patients

Abstract

Aim: To assess the effects of chronic evening oral administration of bromazepam alone or in combination with propranolol on ambulatory blood pressure (BP) and heart rate (HR) in mild hypertensive subjects. Methods: Thirty-seven mild hypertensive patients after a 2-week placebo period were randomized to bromazepam 3 mg, propranolol 40 mg, bromazepam 3 mg plus propranolol 40 mg or placebo for 2 weeks according to a double-blind, double dummy, cross-over design. After each treatment period, 24-h BP and HR ambulatory monitoring was performed by using a non-invasive device. Results: Ambulatory monitoring showed that during night-time SBP and DBP values were unaffected by bromazepam as compared to placebo, whereas SBP was significantly reduced by propranolol both when taken alone and in combination with bromazepam. HR nocturnal values were significantly reduced by propranolol, whereas they were significantly increased by bromazepan both when taken alone (+11.5%, p < 0.05 vs. placebo) and in combination with propranolol (+12.8%, p < 0.05 vs. propranolol). No significant difference in day-time values of SBP, DBP and HR was observed among the 4 treatment groups. Conclusions: In mild hypertensive patients, evening consumption of bromazepam for a 2-week period did not affect BP, while it increased nocturnal HR. Such an increase was observed both when bromazepam was taken alone and in combination with propranolol, which suggests that it depends on a bromazepam mediated decrease in vagal tone. Whatever the mechanism, the HR nocturnal increase might be of clinical relevance, due to the role of high HR as cardiovascular risk factor, particularly in already at risk hypertensive subjects.

Use of Benzodiazepines in Hypertension Treatment

“…The authors considered that the increase in HR observed with bromazepam depends on a reduction in the vagal tone mediated by this psychotropic drug, which could have clinical relevance, particularly in already at-risk hypertensive subjects. (29) In 2021, the same authors published another study evaluating cardiovascular parameters (24-hour SBP, DBP and HR) after 2-week alprazolam and lorazepam consumption (used as hypnotics) in mild hypertensive patients. The study included 32 individuals, between 40 and 65 years of age, with SBP between 140 and 160 mmHg and/or DBP between 90 and 99 mmHg, with no medical treatment, without other comorbidities and with normal values in depressive and anxiety disorder scales.…”

Uso de benzodiazepinas en el manejo de la Hipertensión Arterial

“…Los autores consideran que el aumento de la FC visto con el bromazepam depende de una disminución del tono vagal mediada por este psicofármaco, y que esto podría tener relevancia clínica, particularmente en sujetos hipertensos que ya están en riesgo. (29) En el año 2021, los mismos autores publicaron otro estudio que evaluó los parámetros cardiovasculares (PAS, PAD y FC de 24 hs) luego de 2 semanas de consumo de alprazolam y lorazepam (utilizados como hipnóticos) en pacientes hipertensos leves. Fueron incluidos 32 individuos, entre 40 a 65 años, con PAS entre 140 y 160 mmHg y/o PAD entre 90 y 99 mmHg, vírgenes de tratamiento médico, sin otras comorbilidades y con valores normales en las escalas de trastornos depresivos y de ansiedad.…”