Effects of Escitalopram on Blood Pressure

Clinical Evidence and Guidelines

The International Society of Hypertension guidelines note that SSRIs, such as escitalopram, cause no increases in blood pressure 1
Major hypertension guidelines, including those from the Hypertension journal, do not include SSRIs like escitalopram in their comprehensive lists of medications that raise blood pressure, instead listing antidepressants like SNRIs and tricyclic antidepressants as those that raise blood pressure 1
The American Heart Association and other organizations implicitly support the use of escitalopram in patients with hypertension by not listing it as a medication that raises blood pressure, with SSRIs being a safer alternative to other antidepressants like SNRIs (2/1 mmHg increase) and tricyclic antidepressants (odds ratio 3.19 for hypertension) 1

When managing hypertension in patients with depression, the American Heart Association recommends that blood pressure should be lowered preferentially with RAS-inhibitors and diuretics, which have lower rates of pharmacological interactions with antidepressants 2
Calcium channel blockers and alpha-1 blockers should be used cautiously in patients on serotonin reuptake inhibitors due to orthostatic hypotension risk, as suggested by guidelines from the European societies 2
Escitalopram represents a safer cardiovascular choice compared to other antidepressant classes for patients requiring treatment of both hypertension and depression, according to the Hypertension guidelines 2