Can use of proton pump inhibitors lead to hypertension?

The discussion explains how long-term use of PPI can disrupt normal endothelial function, mineral balance, and vascular control, eventually leading to hypertension.

Balancing a medicine's therapeutic advantages with its possible risks and side effects is a critical part of drug regulation and medical practice. When a drug is designed for the treatment of a medical condition or a particular disease ends up causing additional risks or side effects that lead to the development of other serious problems, it can have detrimental consequences for patients.

PPIs are highly regarded for their effectiveness in addressing several issues related to stomach acid and hold a significant place in today’s medical landscape. PPIs are primarily prescribed by healthcare professionals, especially gastroenterologists or doctors who specialize in treating gastrointestinal conditions. These medical professionals are trained to diagnose and manage conditions including gastroesophageal reflux disease (GERD), peptic ulcers, H. pylori infection, and Zollinger-Ellison syndrome for which PPIs are commonly prescribed.

Rohit Tayal, Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India, and colleagues explored the correlation between persistent use of proton pump inhibitors and hypertension, a common cardiovascular ailment.

"While proton pump inhibitors are beneficial in treating several gastrointestinal problems, their availability without a prescription has led to self-medication and long-term use without medical monitoring," the researchers wrote.

Recent findings have shown a link between long-term PPI use and increased cardiovascular risks, particularly hypertension. In the study, the researchers investigated the intricate mechanisms underlying PPI’s effects, focusing on potential pathways that lead to hypertension, such as disruption of nitric oxide bioavailability, endothelial dysfunction, hypomagnesemia, hypocalcemia, and vitamin B deficiency.

"While the relationship between PPIs and hypertension needs further exploration, the evidence indicates the need for cautious prescribing and a balanced approach to PPI usage," the researchers wrote.

Understanding these pathways provides valuable insights into the complex interplay between PPIs and hypertension, enabling better patient management and developing strategies to mitigate this possible side effect. However, present clinical and preclinical evidence is not adequate to prove the exact relationship between chronic PPI use and hypertension.

The researchers suggest that a better understanding of the connection between PPIs and hypertension will emerge with progress in additional research. Therefore, they feel the need for further research to establish a definitive causal relationship and develop guidelines for healthcare providers.

"Awareness among clinicians and regular blood pressure monitoring in patients on long-term PPI therapy is important to ensure optimal management of their overall health," they concluded.

Reference:

Tayal, R., Yasmin, S., Chauhan, S., Singh, T. G., Saini, M., Shorog, E., Althubyani, M. M., Alsaadi, B. H., Aljohani, F., Alenazi, M. A., Abutaily, S. A., & Ansari, M. Y. (2023). Are Proton Pump Inhibitors Contributing in Emerging New Hypertensive Population? Pharmaceuticals, 16(10), 1387. https://doi.org/10.3390/ph16101387