Hypertension and orthostatic hypotension with venlafaxine treatment in depressed older adults

Abstract

Background: Venlafaxine, a serotonin–norepinephrine reuptake inhibitor, is often used as first- or second-line therapy for depression in older adults. It can be associated with adverse blood pressure (BP) effects. Methods: Adults ⩾60 years of age in a current major depressive episode were treated in a protocolized manner with venlafaxine XR; 429 participants were treated for 8–16 weeks with a daily dose up to 300 mg to achieve remission from depression. Cardiac measures included sitting and standing BP and heart rate. Results: Of participants who were normotensive at baseline, 6.5% were found to have elevated BP during the study (1.9% <225 mg/day; 9.8% ⩾225 mg/day). There was no significant change in mean BP in the overall sample, or in the subgroup treated with doses ⩾225 mg/day. Additionally, 20.1% of the participants who did not have orthostatic hypotension at baseline were found to have orthostatic hypotension (16.8% <225 mg/day; 22.4% ⩾225 mg/day). Participants with new-onset orthostatic hypotension were significantly more likely to fall than the other participants. Conclusion: A large proportion of older adults treated with venlafaxine experience orthostatic hypotension, putting them at risk for falls. A smaller proportion experience elevated BP. Older patients prescribed venlafaxine, particularly at high doses, should be advised and counseled about these adverse effects.

Antidepressant Drugs Effects on Blood Pressure

“…The immediate-release formulation of venlafaxine can induce sustained diastolic hypertension in 10–15% of patients with a lower risk of raising BP with the extended-release formulation. The extended-release formulation of venlafaxine has been related to BP elevation in almost 6% of patients, whereas orthostatic hypotension is even three times more frequent; it ought to be noted that two of three of those who developed orthostatic hypotension took cardiovascular drugs, and 44% were treated with benzodiazepines ( 104 ). Chronic venlafaxine treatment not only determines a sustained increase in BP (diastolic BP increase up to 15 mmHg) ( 105 ) but can also facilitate the occurrence of hypertensive crisis in normotensive patients as well ( 53 , 106 – 108 ).…”

Resistant hypertension

“…Tricyclic agents, such as venlafaxine, have also been shown to have HTN properties in a dose dependent manner [17]. The extended-release formulation of venlafaxine has been related to BP elevation in almost 6% of patients [18].…”

Проблема Безпеки Фармакотерапії Афективних Розладів: Нові Можливості

“…Також слід зазначити, що, з одного боку, підвищення артеріального тиску, з іншого -ортостатична гіпотензія є найчастішими ускладненнями при лікуванні венлафаксином (особливо на початковому етапі терапії) [13,14].…”