Venlafaxine and hypertension

• venlafaxine has been associated with reports of hypertension since its introduction - a meta-analysis of phase III trials (3,744 patients) revealed that diastolic hypertension was only seen more significantly in patients treated with doses of venlafaxine more than 300 mg per day (1). The rate of hypertension varied with respect to dose of venlafaxine:
  • 1.7% on doses less than 101 mg per day
  • 3.5% on doses 101-200 mg per day
  • 3.7% on doses 201-300 mg per day
  • 9.1% on doses over 300 mg per day
  • rate of hypertension in depressed patients taking placebo was 2.2%
    
    
• in patients taking high dose venlafaxine, the mean increase diastolic blood pressure was 7-10 mmHg
  
  
• in patients developing hypertension with venlafaxine a simple dose reduction may suffice to treat the hypertension (with subsequent careful monitoring of blood pressure) - if this measure is unsuccessfull or there is a recurrence of the depression then a different drug should be used

Reference:

• Thase ME. Effects of venlafaxine on blood pressure: a meta-analysis of original data from 3,744 depressed patients. J Clin Psychiatry 1998;59 (10):502-8.
• Prescribers' Journal 2000; 40 (2):169-174.