Table 4.
Therapeutic agents and intoxicants associated with secondary hypertension in dogs and cats
| Agent | Species | Notes |
|---|---|---|
| Glucocorticoids | Dog | • Statistically significant, mild to moderate, dose‐dependent increases in BP noted at dosages sufficient to induce signs of iatrogenic hyperadrenocorticism.240, 241, 242
• Systemic hypertension (ie, SBP ≥160) is uncommon in dogs administered agents with pure glucocorticoid activity at clinically relevant dosages.240, 242, 243, 244 |
| Mineralocorticoids | Dog | • At high dosages and in normal dogs, administration of desoxycorticosterone (DOC) is associated with statistically significant increases in BP,245, 246 most especially when combined with unilateral nephrectomy or high dietary sodium intake.247, 248
• Desoxycorticosterone pivalate (DOCP), administered at clinically relevant dosage rate (2.2 mg/kg IM q 30 days) to dogs with naturally occurring hypoadrenocorticism was not associated with significant increase in BP.249 |
| Erythropoiesis‐stimulating agents | Dog, cat | • Worsening or onset of systemic HT is common in animals with CKD related anemia when treated with recombinant human erythropoietin,250 recombinant canine or feline erythropoietin,251, 252 or darbepoetin alfa.253, 254
• 96% of dogs administered darbepoetin alfa experienced an increase in BP253 • 37% of previously normotensive cats developed HT during darbepoetin alfa treatment254 • HT noted in 40% and 50% of dogs and cats, respectively, treated with rhEPO250 • It is difficult to know to what degree disease progression alone contributes to observed BP increases. |
| Phenylpropanolamine (PPA) | Dog | • Normal dogs administered PPA (1.5‐12.5 mg/kg PO), experience transient, significant increases in BP peak 30‐120 minutes post‐dose and last approximately 3‐5 hours.255
• Persistent HT is uncommon when administered long‐term at recommended dosage (1.5 mg/kg PO q8h) in incontinent dogs.256, 257 • At high doses, acute intoxication may cause severe systemic HT.258, 259 |
| Phenylephrine hydrochloride | Dog | Systemic HT reported in normal dogs,260 and those scheduled for cataract surgery,261 administered topical ocular phenylephrine hydrochloride. |
| Ephedrine | Dog | Significant increases in direct BP were noted in normal dogs administered ephedrine (1.5 mg/kg PO q12h).262 |
| Pseudoephedrine | Dog | • At high doses, acute intoxication may cause systemic HT.263
• When administered for long term to dogs with urinary incontinence, significant increases in indirect BP were not noted.257 |
| Toceranib phosphate | Dog | Systemic HT documented in 28% of previously normotensive dogs treated for various neoplastic diseases for 14 days.264 |
| Chronic, high‐dose sodium chloride | • BP in normal cats and dogs appears to be relatively salt‐insensitive.134, 265, 266, 267
• High‐sodium diets do not appear to promote HT in cats with reduced renal function,131, 266 and salt‐induced HT in the dog seems to be limited to experimental models that also involve nephrectomy268, 269 or mineralocorticoid administration.248 • BP effects of high‐sodium intake in cats and dogs with pre‐existing naturally occurring systemic HT, have not been systematically evaluated. |
|
| Intoxicants with which systemic hypertension has been reported/associated: | ||
| Cocaine270, 271 | Dog | |
| Methamphetamine/amphetamine272, 273, 274 | Dog | |
| 5‐hydroxytryptophan275 | Dog | |
| Agents associated with systemic hypertension in people, but whose BP effects have not been well characterized in dogs and cats: guarana (caffeine), ma huang (ephedrine), tacrolimus, licorice, and bitter orange.276, 277 | ||