Addiction and Hypertension
Almost 24% of adults in the United States have hypertension (high blood pressure). The prevalence of high blood pressure in the addicted population varies depending on the substance the individual chooses to use and the type of high blood pressure the individual has experienced. There are many reasons that those with addiction have high blood pressure, which we will detail below. In addition, there are three basic types of high blood pressure that addicts encounter: primary hypertension, secondary hypertension, and portal hypertension.
Primary Hypertension
Primary hypertension is commonly encountered by substance abusers, and is related to age and genetics. Use of substances may affect the ability to treat high blood pressure successfully though discontinuing use of substances will likely not stop high blood pressure symptoms.
Secondary Hypertension
Secondary hypertension is caused by another disease process or another substance, and is frequently seen with stimulant (uppers) use. Cocaine users are especially prone to high blood pressure. It can also be seen with use of alcohol if the disease has progressed enough to cause kidney problems because the kidneys are important in blood pressure control. Opiates are eliminated by the kidneys, which over time can cause kidney damage which results in high blood pressure. Smoking tobacco and cannabis (marijuana) also causes secondary high blood pressure. Discontinuation of use of any of these substances will typically cause secondary high blood pressure to disappear within a few weeks.
Symptoms of Primary and Secondary Hypertension
Symptoms of high blood pressure are not always present but can include headaches (especially at the back of the head and in the morning), lightheadedness, ringing of the ears, blurred vision, nosebleeds or fainting spells. Your physician may want you to take your blood pressure at home over a period of time to determine if your blood pressure becomes elevated in certain circumstances and to track your blood pressure in your home where you may be more comfortable and less anxious than you are in a doctor’s office (anxiety and tension tend to raise blood pressure readings).
Treatment of Primary and Secondary Hypertension
Treatment of primary and secondary hypertension usually starts with reducing your salt intake. If reducing the amount of salty foods and drinks in your diet does not reduce your blood pressure significantly, most doctors will place you on a medication to reduce your blood pressure. It is extremely important to take this medication as directed. Many of these medications have side effects. It is important that you keep your doctor informed about any side effects you experience. Sometimes persons who first start medications find that their blood pressure drops too much. Close contact with your doctor is advised when first starting blood pressure medication.
Persons who use cocaine may be at risk for having a “hypertensive crisis.” In other words, the blood pressure rises to an extreme, and usually the heart rate is also very high. Treatment of this in a cocaine user is very different from treatment of individuals who do not use cocaine. The normal type of treatment may make symptoms worse, which can be life threatening. Therefore, it is especially important that you discuss your use of cocaine with the doctor that is treating you if this should occur.
If you choose not to treat your high blood pressure, you put yourself at risk of heart attack, stroke, hemorrhage of the retina of the eye, and kidney disease.
Portal Hypertension
Portal hypertension is seen primarily in individuals who have cirrhosis of the liver. Its name comes from the vein (portal vein) that leads into the liver. Blood backs up in this large vein because it is unable to pass through the scarred tissue of the liver. Symptoms of portal hypertension include coughing or spitting up blood as a result of bleeding of the veins in the esophagus or stomach, black tarry stools, enlargement of the spleen and liver, and collection of fluid in the abdominal cavity causing abdominal distention or swelling.
Treatment of Portal Hypertension
Treatment of portal hypertension is usually only done to treat the symptoms, which includes controlling the bleeding of varicose veins of the esophagus and stomach, and drawing fluid from the abdominal cavity when abdominal swelling becomes uncomfortable. Persons with portal hypertension are typically put on a low sodium, low protein diet (sodium or salt and protein are processed by the liver, and the process of digesting these foods can cause many of the uncomfortable symptoms of portal hypertension).
Conclusion
The good news is that if you have secondary hypertension and you stop using drugs or alcohol, you will likely be able to discontinue treatment. Typically, individuals with primary hypertension will need treatment whether they continue to use substances or not, however, discontinuing use of substances may allow you to achieve better control of your blood pressure, and reduce your dosage of medication, which therefore reduces any side effects that you may experience as a result of taking medication. In any case, it is very important that you maintain close contact with your doctor as you adapt to a life of abstinence from drugs and/or alcohol.
Bibliography
Ceccanti, M., Sasso, G.F., Nocente, R. et al (2006) Hypertension in Early Alcohol Withdrawal in Chronic Alcoholics. Alcohol Y Alcoholism, V41(1), 5-10.
Crowe, A.V., Howse, M., Bell, G.M. and Henry, J.A. (2000) Substance Abuse and the Kidney. QJM: An International Journal of Medicine, V93, 147-152.
Egan, B.M. (2004) Hypertension in the 21st Century: The Tide is Rising; Our Daze Must End. Hypertension, V44, 389.
Epstein, M. (1997) Alcohol’s Impact on Kidney Function. Alcohol, Health & Research World, V21(1), 84-93.
Hollander, J.E. (2008) Cocaine Intoxication and Hypertension. Annals of Emergency Medicine, V51(3), S18-S20.
Miller, P.M., Spies, C., Neumann, T. et al (2006)Alcohol Biomarker Screening in Medical and Surgical Settings. Alcohol Clinical and Experimental Research, V30(2), 185-193.