Hydroxyzine and Blood Pressure Management

Evidence from Guidelines

• The American Heart Association, American College of Cardiology, and European Society of Cardiology do not recommend hydroxyzine or any antihistamines for hypertension treatment, instead suggesting thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers as first-line agents for blood pressure control 1, 2, 3
• The American College of Cardiology recommends thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers as first-line agents for blood pressure control, with no mention of hydroxyzine 3

Clinical Role of Hydroxyzine

• Hydroxyzine is classified as a sedating first-generation antihistamine, primarily indicated for allergic rhinitis, urticaria, and anxiety-related conditions, with sedative effects and anticholinergic properties 4, 5
• The European Society of Cardiology does not include hydroxyzine in its recommended treatment algorithms for hypertension, due to its primary indications being allergic conditions and anxiety 2

Drugs That Should Be Avoided in Hypertension

• The American Heart Association identifies nondihydropyridine calcium channel blockers (verapamil, diltiazem), moxonidine, and alpha-blockers like doxazosin as drugs to avoid in patients with heart failure and hypertension, with hydroxyzine not being mentioned due to its non-cardiovascular indications 1, 6, 7
• The American College of Cardiology recommends avoiding nondihydropyridine calcium channel blockers, moxonidine, and alpha-blockers in patients with heart failure and hypertension 1, 6

Important Clinical Considerations

• For patients requiring both blood pressure management and treatment for allergies or anxiety, the American Heart Association recommends treating hypertension with evidence-based antihypertensive medications, and using second-generation antihistamines instead of hydroxyzine due to their fewer sedative and anticholinergic effects 3, 4, 5
• Hydroxyzine should be avoided in patients with severe liver disease or severe renal impairment, and is contraindicated in early pregnancy, further limiting its use in patients with comorbid conditions associated with hypertension 4