Sertraline-Associated Hypertension
Sertraline has been associated with increased blood pressure and hypertension in postmarketing and/or adverse-reaction listings. [1] Clinically significant sustained hypertension is not a common hallmark reaction, but blood pressure elevations can occur. [1]
Evidence From Prescribing Information
Sertraline prescribing information lists hypertension under “Vascular Disorders” among adverse reactions. [1] The same prescribing information also describes serotonin syndrome as a potential cause of autonomic instability with labile blood pressure during serotonergic toxicity. [2]
Mechanistic Considerations
Serotonin syndrome can cause autonomic instability, which may include labile blood pressure. [2] Sympathomimetic physiology from serotonergic toxicity can produce transient blood pressure elevations. [2]
Clinical Scenarios Where Blood Pressure Elevation Is More Likely
Blood pressure increases are more likely in the context of serotonergic toxicity presentations consistent with serotonin syndrome. [2] Blood pressure elevations can also occur in susceptible patients receiving sertraline despite stable comorbid cardiovascular disease. [1]
Monitoring and Practical Clinical Approach
Blood pressure should be assessed at baseline and monitored after initiation or dose increases of sertraline in patients with known hypertension or cardiovascular risk. [1] Sertraline should be reassessed promptly when hypertension emerges temporally after initiation or dose escalation. [1]
When to Treat as a Serious Adverse Reaction
Serotonin syndrome should be considered when hypertension occurs with other autonomic instability features (for example, tachycardia, diaphoresis, agitation) and neuromuscular findings (for example, tremor, hyperreflexia). [2]
Summary Statement
Sertraline can cause hypertension or blood pressure increases, as reflected in adverse-reaction listings and in serotonin syndrome presentations that include labile blood pressure. [1] [2]