Certain blood pressure medications are sometimes used to treat anxiety or its symptoms. Though they're not front-line anxiety treatments, they may be good options if you require treatment for both anxiety and high blood pressure or if you can't tolerate more commonly prescribed anxiety drugs.
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Some studies suggest that blood pressure medications may be helpful in reducing anxiety or its symptoms. But this is considered an off-label use, which is when a medication is used for a medical condition that it's not approved to treat, according to the Food and Drug Administration.
Blood pressure medicines that have been used to help treat anxiety and related disorders include verapamil (a calcium channel blocker), propranolol and atenolol (beta blockers). These blood pressure medications, though not commonly prescribed for anxiety today, may indeed be helpful, says Philip Muskin, MD, professor of psychiatry at Columbia University Irving Medical Center in New York city and past secretary of the American Psychiatric Association.
"If you are taking any of these drugs for hypertension, you may have an anti-anxiety side benefit. I think that's fair to say," Dr. Muskin says. "I do have a couple of people who have performance anxiety and I have prescribed propranolol for them. There's also some data that propranolol can help with post-traumatic stress disorder."
An April 2016 study in Neurobiology of Learning and Memory found that propranolol, combined with behavioral therapy, may help ease fear in people with post traumatic stress disorder soon after a traumatic event and possibly dampen fear memories.
Anxiety doesn't directly cause long-term high blood pressure, but it can trigger temporary spikes in blood pressure, according to the Mayo Clinic. Some anxiety medications can also raise blood pressure in some people, which makes treating both more challenging.
Not everyone responds to medications in the same way, so what works for one person may not work for you. It's important that all your doctors are aware of your medications, so you can avoid undesirable interactions or complications.
Blood Pressure Medications for Anxiety
"When blood pressure medications are needed in a patient who also has chronic or periodic anxiety, if there is no other contraindication, a beta blocker and some, but not all, calcium channel blockers could be an excellent choice," says Catherine Collings, MD, a cardiologist and director of lifestyle medicine at El Camino Health in northern California.
Beta blockers block the hormone epinephrine, according to the Mayo Clinic. Epinephrine — also known as adrenaline — is related to the fight-or-flight response, which can lead to anxiety if that fight-or-flight response stays activated long-term, Mayo Clinic says. Reducing the effects of adrenaline may help reduce anxiety or its intensity.
Beta blockers can be used to help lessen physical anxiety symptoms, like rapid heartbeat or trembling, says the National Institute of Mental Health. Still, the evidence for beta blockers as an anxiety treatment isn't firm. A February 2016 review in the Journal of Psychopharmacology found insufficient evidence to support the routine use of propranolol to treat anxiety disorders.
Calcium channel blockers prevent calcium from entering the cells of the heart and blood vessels, according to the National Cancer Institute. By blocking calcium, these medications allow blood vessels to relax and open, helping lower blood pressure. Verapamil has been used to treat anxiety and other mood disorders. However, very few clinical studies have been done, and those that were showed mixed results.
Though evidence isn't strong enough to make these medications standard treatments for anxiety, if you're being treated for anxiety and high blood pressure, one of them might be a good option.
"It certainly wouldn't be first-line treatment, but it could be useful in special circumstances, such as if a person couldn't tolerate more commonly prescribed medications," Dr. Muskin says.
For most people with anxiety disorders, other drugs designed for mood disorders are likely to be more effective, says Dr. Muskin. Most treatment guidelines recommend serotonin reuptake inhibitors (SSRIs), such as escitalopram or fluoxetine, according to the Anxiety and Depression Association of America.
Other Considerations: Lifestyle Changes
A healthy lifestyle may help improve your physical and mental health, including helping manage blood pressure and anxiety.
"Lifestyle should be the first, second and third step for people with high blood pressure and anxiety, unless blood pressure or anxiety are at critical levels," Dr. Collings says.
She recommends a whole-food, plant-predominant diet low in sodium, processed foods and alcohol; cardio and weight resistance exercise; and stress-reducing measures like cognitive behavioral therapy and yoga.
Is This an Emergency?
- Mayo Clinic: “Anxiety: A Cause of High Blood Pressure?”
- Journal of Psychopharmacology: “Propranolol for the Treatment of Anxiety Disorders: Systematic Review and Meta-Analysis”
- Catherine Collings, MD, director of lifestyle medicine at El Camino Health, Northern California, and president-elect of the American College of Lifestyle Medicine
- U.S. Food and Drug Administration: "Understanding Unapproved Use of Approved Drugs 'Off Label'"
- Philip Muskin, MD, professor of psychiatry, Columbia University Irving Medical Center, New York City, and past secretary, American Psychiatric Association
- Neurobiology of Learning and Memory: "Revisiting Propranolol and PTSD: Memory Erasure or Extinction Enhancement?"
- Mayo Clinic: "Beta Blockers"
- Mayo Clinic: "Stress Management"
- National Institute of Mental Health: "Anxiety Disorders"
- National Cancer Institute: “Calcium Channel Blocker”
- Anxiety and Depression Association of America: "Clinical Practice Review for GAD"