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Effects of Venlafaxine on Blood Pressure: A Meta-Analysis of Original Data From 3744 Depressed Patients
Abstract
BACKGROUND: Venlafaxine hydrochloride, a structurally novel antidepressant, is also the first nontricyclic serotonin/norepinephrine reuptake inhibitor. Although venlafaxine has an overall side effect and safety profile that is comparable to other newer antidepressants, it can cause both transient and sustained elevations of supine diastolic blood pressure (SDBP), probably the result of noradrenergic potentiation. METHOD: Presented here is a meta-analysis of original data on blood pressure, using both random effects and a multivariate survival analyses. The sample consisted of 3744 patients with major depression who were studied in controlled clinical trials comparing venlafaxine with imipramine and/or placebo. Patients were treated for 6 weeks of acute phase therapy; some responders received up to 1 year of continuation phase therapy. RESULTS: Venlafaxine and imipramine were associated with small, but statistically significant, increases in SDBP during acute phase therapy. When compared with imipramine and placebo, venlafaxine was also associated with a greater proportion of persistent elevations of SDBP during continuation therapy. The effect of venlafaxine was highly dose dependent, and the incidence of elevated SDBP was statistically and clinically significant only at dosages above 300 mg/day. Venlafaxine did not adversely affect the control of blood pressure for patients with preexisting high blood pressure or elevated baseline values. CONCLUSION: Venlafaxine has a dose-dependent effect on SDBP that is clinically significant at high dosages. Concern about blood pressure effects should not deter first-line use of this effective antidepressant, although more extensive studies of patients with cardiovascular diseases are still necessary.
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“Likewise, dose-dependent increases in BP have been reported in patients receiving therapeutic doses of venlafaxine.247”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [247]
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“…" effect at higher doses may result in some additional therapeutic benefit relative to SSRIs (Clerc et al 1994; Dierick et al 1996; Poirier and Boyer 1999), although venlafaxine therapy at doses above 300 mg/day is associated with an 8%–10% incidence of increased blood pressure (Thase 1998).”
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Zhang, L., Chappell, J., Gonzales, C., Small, D. S., Knadler, M. P., Callaghan, J. T., Francis, J. L., Desaiah, D., Leibowitz, M. T., Ereshefsky, L., et al. (2007) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0b013e318030aff7 · Cited by 58
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“The most serious potential adverse effect is dose-related hypertension, and monitoring of blood pressure is recommended, especially in patients taking higher doses (more than 200 mg/day) (42).”
BackgroundBernard, N., Forest, J., Tarabulsy, G. M., Bujold, E., Bouvier, D., & Giguère, Y. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2285-8 · Cited by 49
“A meta-analysis suggested that SNRI drugs, probably via their noradrenergic effects, can cause elevations of diastolic blood pressure [51].”
BackgroundTreatment of insomnia in patients with mood disorders
Nowell, P. D., & Buysse, D. J. (2001) · Depression and Anxiety · doi:10.1002/da.1042 · Cited by 50
“Having reviewed the evidence to support various treatments for insomnia associated with mood disorders, it may help to place some of these suggestions in perspective and to offer practical suggestions [Kupfer, 1999; Neylan, 1995; Thase, 1998].”
Zhong, Z., Wang, L., Wen, X., Liu, Y., Fan, Y., & Liu, Z. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s141832 · Cited by 46
“Incidence of clinically significant increases in BP can be lower at doses below 200 mg daily, 13 and only doses above 300 mg/day lead to statistical and clinical significance of the incidence of elevated supine DBP. 14 A previous study reported that duloxetine at suprath-erapeutic doses increases supine SBP and DBP by…”
InfluentialDrug-Induced Hypertension: Focus on Mechanisms and Management
Lovell, A. R., & Ernst, M. E. (2017) · Current Hypertension Reports · doi:10.1007/s11906-017-0736-z · Cited by 47
Raina, J., El-Messidi, A., Badeghiesh, A., Tulandi, T., Nguyen, T.-V., & Suarthana, E. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.10.058 · Cited by 48
Antidepressant medication use, depression, and the risk of preeclampsia
Avalos, L. A., Chen, H., & Li, D. (2015) · CNS Spectrums · doi:10.1017/s1092852915000024 · Cited by 46
Drug-induced arterial hypertension – a frequently ignored cause of secondary hypertension: a review
Diaconu, C. C., Dediu, G. N., & Iancu, M. A. (2018) · Acta cardiologica. Supplementum · doi:10.1080/00015385.2017.1421445 · Cited by 46
“Treatment with venlafaxine is associated with a small, but statistically significant, increase of blood pressure during acute treatment and also with persistent elevations of blood pressure during chronic therapy [24].”
BackgroundCompliance: the impact of adverse events and tolerability on the physician’s treatment decisions
Roose, S. P. (2003) · European Neuropsychopharmacology · doi:10.1016/s0924-977x(03)00097-x · Cited by 46
Treatment of Depression in Patients with Coronary Heart Disease
Vieweg, W. V. R., Julius, D. A., Fernandez, A., Wulsin, L. R., Mohanty, P. K., Beatty-Brooks, M., Hasnain, M., & Pandurangi, A. K. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.02.037 · Cited by 50
Bipolar depression: Diagnostic and treatment considerations
Thase, M. E. (2006) · Development and Psychopathology · doi:10.1017/s0954579406060585 · Cited by 46
“…therapy also is associated with a somewhat greater side effect burden than the SSRIs, which includes a dose-dependent risk of hypertension ~Thase, 1998!. Fourth, results of several pharmacoepidemiologic studies suggest that venlafaxine may be more toxic in overdose than the SSRIs…”
Self-citationDrug-induced Pneumonitis and Heart Failure Simultaneously Associated with Venlafaxine
Drent, M., Singh, S., Gorgels, A. P. M., et al. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200207-739cr · Cited by 45
The Safety and Tolerability of Duloxetine Compared With Paroxetine and Placebo
Nelson, J. C., Pritchett, Y., Martynov, O., Yu, J., Mallinckrodt, C. H., & Detke, M. J. (2006) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.v08n0404 · Cited by 44
“Among the newer antidepressants (SNRIs), venlafaxine has been associated with an increased rate of sustained hypertension.(5) In the current study, neither duloxetine nor paroxetine was associated with significant increases in mean blood pressure or sustained hypertension.”
BackgroundThe Effects of Pain and Analgesic Medications on Blood Pressure
Rivasi, G., Menale, S., Turrin, G., Coscarelli, A., Giordano, A., & Ungar, A. (2022) · Current Hypertension Reports · doi:10.1007/s11906-022-01205-5 · Cited by 47
Foy, M. C., Vaishnav, J., & Sperati, C. J. (2019) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2019.08.013 · Cited by 43
Hypertensive crisis associated with venlafaxine
Khurana, R. N., & Baudendistel, T. E. (2003) · The American Journal of Medicine · doi:10.1016/s0002-9343(03)00472-8 · Cited by 42
Panic & Plaques: Panic Disorder & Coronary Artery Disease in Patients with Chest Pain
Katerndahl, D. A. (2004) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.17.2.114 · Cited by 40
Metadata
- Authors
- Thase, M. E.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Thase, Michael E.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 1998-10-15
- Volume
- 59
- Issue
- 10
- Pages
- 502-508
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2074133854
- Cited by
- 331
- References
- 0
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 14 · 2023: 3 · 2022: 11 · 2021: 6 · 2020: 7 · 2019: 16 · 2018: 11 · 2017: 9 · 2016: 13 · 2015: 15 · 2014: 14 · 2013: 10 · 2012: 12
- FWCI
- 4.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH30915)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- venlafaxine, blood pressure, serotonin-norepinephrine reuptake inhibitors, major depressive disorder, imipramine, dose dependence, antihypertensive effect, antidepressant side effects
- MeSH terms
- Venlafaxine Hydrochloride, Adult, Aged, Blood Pressure, Cyclohexanols, Depressive Disorder, Diastole, Dose-Response Relationship, Drug, Female, Humans, Hypertension, Male, Middle Aged, Posture, Regression Analysis, Incidence, Proportional Hazards Models, Antidepressive Agents, Second-Generation
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