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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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Pharmacological treatment options for panic disorder in children and adolescents
Masi, G., Pari, C., & Millepiedi, S. (2006) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.7.5.545 · Cited by 12
“According to adult data, this drug can increase blood pressure in a dose-related manner [76].”
BackgroundUse of antidepressant drugs in transplant recipients
Kim, J., Phongsamran, P. V., & Park, S. J. (2004) · Progress in Transplantation · doi:10.7182/prtr.14.2.40w9186064m78653 · Cited by 12
Psychiatric Medications and Hypertension
Morreale, M. K., & Wake, L. (2020) · Current Hypertension Reports · doi:10.1007/s11906-020-01096-4 · Cited by 12
Carlo, V. D., Grancini, B. M., Cassina, N., Casati, L., Piccoli, E., Vismara, M. E. M., Gobbo, D., Zanaschi, R., Lupo, S., Olivieri, S., et al. (2022) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000448 · Cited by 13
“antidepressants, such as bupropion, venlafaxine or esketamine, could have a significant effect on blood pressure elevation (Thase, 1998; Teply et al., 2016; Doherty et al., 2020), antipsychotic medications are known to cause orthostatic hypotension (Gugger, 2011).”
BackgroundTratamento de idosos com depressão utilizando tricíclicos, IMAO, ISRS e outros antidepressivos
Scalco, M. Z. (2002) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462002000500011 · Cited by 16
Alexandrino-Silva, C., Mauá, F. H. N., de Andrade, A. G., & Alves, T. C. T. F. (2008) · Journal of Psychopharmacology · doi:10.1177/0269881107076403 · Cited by 12
Venlafaxine as single therapy associated with hypertensive encephalopathy
Edvardsson, B. (2015) · SpringerPlus · doi:10.1186/s40064-015-0883-0 · Cited by 12
“The rise of blood pressure is dose dependent, happening more often at higher doses (Thase 1998).”
BackgroundResultBalfour, J. A. B., & Jarvis, B. (2000) · CNS Drugs · doi:10.2165/00023210-200014060-00006 · Cited by 11
Elevation of blood pressure induced by high‐dose milnacipran
Yoshida, K., Higuchi, H., Takahashi, H., et al. (2002) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.432 · Cited by 12
“Thase (1998) reported that venlafaxine elevated supine diastolic blood pressure at high dosages of more than 300mg/day in a meta-analysis of original data from 3744 depressed patients.”
BackgroundIs it safe to use antidepressants after a stroke?
Rampello, L., Battaglia, G., Raffaele, R., Vecchio, I., & Alvano, A. (2005) · Expert Opinion on Drug Safety · doi:10.1517/14740338.4.5.885 · Cited by 13
“In addition, venlafaxine seems safe in patients with vascular diseases, but caution is recommended at high doses (300 mg daily) owing to a dose-dependent blood pressure increase in averaging 7 mmHg diastolic at the highest dose [62].”
BackgroundAntidepressant Use and Subclinical Measures of Atherosclerosis
Camacho, Á., McClelland, R. L., Delaney, J. A., Allison, M., Psaty, B. M., Rifkin, D. E., Rapp, S. R., Szklo, M., Stein, M. B., & Criqui, M. H. (2016) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000518 · Cited by 11
“Furthermore, open-label trials of 12 weeks' duration and a meta-analysis have reported an association of exposure to SNRIs with increased blood pressure compared with non-SNRIs users.(12,13) Even though such studies have suggested that antidepressants, especially SSRIs, are not associated with higher risk of atheroscl…”
Is Mania the Hypertension of the Mood? Discussion of A Hypothesis
Rihmer, Z., Gonda, X., & Döme, P. (2017) · Current Neuropharmacology · doi:10.2174/1570159x14666160902145635 · Cited by 12
“Consequentially in contrast to yohimbine mirtazapine typically decreases blood pressure [56-58]. c) Dual action antidepressants (i.e. serotonin/noradrenaline reuptake inhibitors like venlafaxine and duloxetine and all TCA antidepressants, particularly the noradrenaline reuptake inhibitor desipramine) induce mania more…”
BackgroundAugustin, M., Schoretsanitis, G., Gründer, G., et al. (2018) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000929 · Cited by 11
Dual serotonin and noradrenaline reuptake inhibitors: Focus on their differences
Blier, P. (2006) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651500600645612 · Cited by 11
“In patients treated with immediate release venlafaxine above 300 mg/day, 13% of patients met the criteria for hypertension [41].”
Background
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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