Skip to main content

Advertisement

SpringerLink
Log in

Benzodiazepines Reduce Blood Pressure in Short Term: A Systematic Review and Meta-analysis

  • Secondary Hypertension: Nervous System Mechanisms (M Wyss, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Benzodiazepines, due to their anxiolytic properties, are prescribed to reduce anxiety and insomnia. They might have hypotensive effect via potentiation of the inhibitory effect of gamma-amino butyric acid (GABA) in the central nervous system and vasodilatory properties. However, studies comparing the effect of benzodiazepines in lowering blood pressure (BP) are equivocal. This systematic review and meta-analysis was planned to assess the efficacy of benzodiazepines in reducing blood pressure in short term among hypertensive patients.

Recent Findings

Various trials and retrospective analysis conducted previously have reported that benzodiazepines cause short- as well as long-term BP reduction in patients with increased anxiety with hypertension. On the other hand, several studies investigating the efficacy of benzodiazepines in patients with hypertension have reported inconclusive results. The primary question about the effect of benzodiazepines in lowering BP remains unanswered.

Summary

In this meta-analysis of seven studies, benzodiazepines were found comparable to standard drugs in reducing systolic and diastolic BP in patients having hypertension. Although, the mean difference in systolic BP with benzodiazepines and placebo was statistically not significant, the difference can be considered as clinically meaningful. The current review offers preliminary evidence that benzodiazepines may have antihypertensive properties and may be used as add-on antihypertensive in a subset of patients in short term. The existing data are encouraging, but more clinical trials and mechanistic research are required to ascertain the long-term benefits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wible JH, DiMicco JA, Luft FC. Hypothalamic GABA and sympathetic regulation in spontaneously hypertensive rats. Hypertension. 1989;14:623–8.

    Article  CAS  PubMed  Google Scholar 

  2. Klockgether-Radke AP, Pawlowski P, Neumann P, Hellige G. Mechanisms involved in the relaxing effect of midazolam on coronary arteries. Eur J Anaesthesiol. 2005;22:135–9.

    Article  CAS  PubMed  Google Scholar 

  3. Nm K. Anxiety-induced hyperventilation. A common cause of symptoms in patients with hypertension. Arch Intern Med [Internet]. 1997;[cited 2023 Jan 8]157. Available from: https://pubmed.ncbi.nlm.nih.gov/9140264/.

  4. White WB, Baker LH. Ambulatory blood pressure monitoring in patients with panic disorder. Arch Intern Med. 1987;147:1973–5.

    Article  CAS  PubMed  Google Scholar 

  5. Pan Y, Cai W, Cheng Q, Dong W, An T, Yan J. Association between anxiety and hypertension: a systematic review and meta-analysis of epidemiological studies. Neuropsychiatr Dis Treat. 2015;11:1121–30.

    PubMed  PubMed Central  Google Scholar 

  6. Esler M, Kaye D. Sympathetic nervous system activation in essential hypertension, cardiac failure and psychosomatic heart disease. J Cardiovasc Pharmacol. 2000;35:S1-7.

    Article  CAS  PubMed  Google Scholar 

  7. Yilmaz S, Pekdemir M, Tural U, Uygun M. Comparison of alprazolam versus captopril in high blood pressure: a randomized controlled trial. Blood Press. 2011;20:239–43.

    Article  CAS  PubMed  Google Scholar 

  8. Tandeter H. Hypothesis: A single dose of an anxiolitic may prevent unnecessary visits to the emergency room during blood pressure elevations. Med Hypotheses. 2016;88:35–7.

    Article  PubMed  Google Scholar 

  9. Watanabe Y, Higuchi H, Ishii-Maruhama M, Honda Y, Yabuki-Kawase A, Yamane-Hirano A, et al. Effect of a low dose of midazolam on high blood pressure in dental patients: a randomised, double-blind, placebo-controlled, two-centre study. Br J Oral Maxillofac Surg. 2016;54:443–8.

    Article  PubMed  Google Scholar 

  10. Grossman E, Nadler M, Sharabi Y, Thaler M, Shachar A, Shamiss A. Antianxiety treatment in patients with excessive hypertension. Am J Hypertens. 2005;18:1174–7.

    Article  CAS  PubMed  Google Scholar 

  11. Mendelson N, Gontmacher B, Vodonos A, Novack V, Abu-AjAj M, Wolak A, et al. Benzodiazepine consumption is associated with lower blood pressure in ambulatory blood pressure monitoring (ABPM): retrospective analysis of 4938 ABPMs. Am J Hypertens. 2018;31:431–7.

    Article  CAS  PubMed  Google Scholar 

  12. Costa A, D’Angelo A, Ramusino MC, Perini G, Bosone D, Derosa G, et al. Effects of oral administration of alprazolam and lorazepam as hypnotics on cardiovascular parameters in hypertensive patients. J Clin Psychopharmacol. 2021;41:191–5.

    Article  CAS  PubMed  Google Scholar 

  13. Costa A, Bosone D, Cotta Ramusino M, Perini G, Ghiotto N, Zoppi A, et al. Effect of evening bromazepam administration on blood pressure and heart rate in mild hypertensive patients. Pharmacology. 2019;104:1–6.

    Article  CAS  PubMed  Google Scholar 

  14. Divac N, Veljković S, Nesić Z, Stojanović R, Bajcetić M, Vasiljević Z, et al. Pattern of utilization of benzodiazepines in patients with hypertension: a pilot study. Vojnosanit Pregl. 2006;63:370–5.

    Article  PubMed  Google Scholar 

  15. Thong JF, Lo S, Houghton R, Moore-Gillon V. A prospective comparative study to examine the effects of oral diazepam on blood pressure and anxiety levels in patients with acute epistaxis. J Laryngol Otol. 2007;121:124–9.

    Article  CAS  PubMed  Google Scholar 

  16. Cochrane handbook for systematic reviews of interventions [Internet]. [cited 2023 Jan 16]. Available from: https://training.cochrane.org/handbook.

  17. Jp H, Sg T, Jj D, Dg A. Measuring inconsistency in meta-analyses. BMJ [Internet]. 2003;[cited 2023 Jan 29]327. Available from: https://pubmed.ncbi.nlm.nih.gov/12958120/.

  18. Khorsand M, Enayatrad M, Yekesadat S, Khodayar M, Noyani A. Efficacy of midazolam administration to control blood pressure in patients diagnosed with ‘Hypertensive crisis’: a randomized clinical trial. 2020.

  19. Mabadeje AF, Adebayo GI. Comparative effects of labetalol and bromazepam on ambulatory blood pressure of Nigerians with labile and stress hypertension. Clin Exp Hypertens A. 1989;11(Suppl 1):441–7.

    PubMed  Google Scholar 

  20. Craske MG, Stein MB. Anxiety Lancet Lond Engl. 2016;388:3048–59.

    Article  Google Scholar 

  21. Fleet R, Lespérance F, Arsenault A, Grégoire J, Lavoie K, Laurin C, et al. Myocardial perfusion study of panic attacks in patients with coronary artery disease. Am J Cardiol. 2005;96:1064–8.

    Article  PubMed  Google Scholar 

  22. Pérez-Piñar M, Ayerbe L, González E, Mathur R, Foguet-Boreu Q, Ayis S. Anxiety disorders and risk of stroke: a systematic review and meta-analysis. Eur Psychiatry J Assoc Eur Psychiatr. 2017;41:102–8.

    Article  Google Scholar 

  23. Emdin CA, Odutayo A, Wong CX, Tran J, Hsiao AJ, Hunn BHM. Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol. 2016;118:511–9.

    Article  PubMed  Google Scholar 

  24. Linden W, Stossel C, Maurice J. Psychosocial interventions for patients with coronary artery disease: a meta-analysis. Arch Intern Med. 1996;156:745–52.

    Article  CAS  PubMed  Google Scholar 

  25. Dusseldorp E, van Elderen T, Maes S, Meulman J, Kraaij V. A meta-analysis of psychoeduational programs for coronary heart disease patients. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 1999;18:506–19.

    CAS  Google Scholar 

  26. Blood Pressure Lowering Treatment Trialists’ Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet Lond Engl. 2021;397:1625–36.

    Article  Google Scholar 

  27. Yeh C-B, Tsai M-C, Teng Y-H, Ku M-S, Huang J-Y, Wang B-Y, et al. Association of alprazolam with major cardiovascular events in patients with hypertension. J Eval Clin Pract. 2020;26:983–91.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacology, Lady Hardinge Medical College & Smt. S.K. Hospital, New Delhi, 110001, India

    Bhupinder Solanki, Ridhi Goel & Lalit K. Gupta

  2. Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, India

    Bhupinder Solanki

Authors
  1. Bhupinder Solanki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ridhi Goel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lalit K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LKG conceived the study. BS and RG captured data. BS, LKG, and RG analyzed the data and prepared results, and interpreted the results. All authors contributed to the first draft and have approved the final manuscript.

Corresponding author

Correspondence to Lalit K. Gupta.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 73 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Solanki, B., Goel, R. & Gupta, L.K. Benzodiazepines Reduce Blood Pressure in Short Term: A Systematic Review and Meta-analysis. Curr Hypertens Rep 25, 335–341 (2023). https://doi.org/10.1007/s11906-023-01256-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-023-01256-2

Keywords

Search

Navigation