Hypertension drug-induced

Headache is one of the most frequent complaints which mankind suffers from. Most commonly the headache starts from one of the pain sensitive structures of the skull, but diseases originating outside the skull are also important causes of headache. Diseases of the eye, sinuses, jaw, teeth and neck often cause headache, but also visceral tissue may give rise to headache. The headache may be secondary to many diseases, e.g. anaemia and hypertension. Drug induced headache is not uncommon, either as an adverse reaction, e.g. to calcium antagonists and SSRIs, or as part of more complex problems in chronic headache. 

Rordorf G, Koroshetz WJ, Ezzeddine MA, Segal AZ, Buonanno FS. A pilot study of drug-induced hypertension for treatment of acute stroke. Neurology 2001 56(9) 1210-1213. 

All drugs inducing a constantly increased serotonin level may induce pulmonary hypertension on the basis of a hypertrophic smooth muscle layer of small pulmonary arteries. 

The injection of a vasoconstrictor, which causes an increase in mean arterial blood pressure, results in activation of the baroreceptors and increased neural input to the cardiovascular centers in the medulla oblongata. The reflex compensation for the drug-induced hypertension includes an increase in parasympathetic nerve activity and a decrease in sympathetic nerve activity. This combined alteration in neural firing reduces cardiac rate and force and the tone of vascular smooth muscle. As a consequence of the altered neural control of both the heart and the blood vessels, the rise in blood pressure induced by the drug is opposed and blunted. 

Toxicities are numerous and include nephrotoxicity, hypertension, hyperglycemia, liver dysfunction, hyperkalemia, altered mental status, seizures, and hirsutism. Cyclosporine causes very little bone marrow toxicity. While an increased incidence of lymphoma and other cancers (Kaposi s sarcoma, skin cancer) have been observed in transplant recipients receiving cyclosporine, other immunosuppressive agents may also predispose recipients to cancer. Some evidence suggests that tumors may arise after cyclosporine treatment because the drug induces TGF-B, which promotes tumor invasion and metastasis. 

The drug hydralazine is a vasodilator used for the treatment of hypertension. In a significant proportion of individuals, it causes a serious adverse effect, drug-induced systemic lupus erythematosus (SLE). This is a systemic kind of toxic effect, as there is no particular target organ or tissue. It is an example of immune-media ted toxicity that involves autoimmunity and shows a number of interesting features. 

A particularly good example of a drug inducing SLE is the vasodilator hydralazine, sometimes used for the treatment of hypertension. The drug-induced lupus syndrome... 

A 43-year-old woman reported depression and attempted suicide after taking valsartan in combination with hydrochlorothiazide for hypertension (670). The patient was also taking atenolol, but the time course and complete resolution after withdrawal of valsartan/hydrochlorothiazide suggested that this was a drug-induced episode of depression. 

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