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January 12, 2018

By A. Weinberg, Contributing Columnist

There are many things that go together really well: cookies and milk,
cats and laser pointers, hard work and money.

However, sometimes something that should make you feel better goes
with something that makes you feel worse. For example, on occasion
blood pressure medication goes with (acute) pancreatitis.

However, this is not hot-off-the-press news. People have been
observing the correlation between drug-induced pancreatitis and
various blood pressure medications since the 1950s.

Luckily, in most countries, the incidence of drug induced acute
pancreatitis is pretty low. For example, in Germany, about 1.4%, in
Japan about 1.2%.

However, that doesn’t mean that the symptoms are any less serious
when they do occur: Hemorrhage, swelling, lack of blood flow, and
death are common. Acute pancreatitis secondary effects can progress
to systemic inflammatory response and multiple organ failure. 3 to 13%
of acute pancreatitis cases will likely lead to chronic pancreatitis.

How Does It Work?

A basic explanation is that the activated pancreatic enzymes digest cell
membranes of the pancreas and activate an inflammatory response.

Because the vascular permeability of the pancreas increases,
hemorrhage and swelling are more likely to occur.

Which medications put you at risk?

Scientists have created a classification system for which medications
will put you at risk.

N. Badalov and colleagues from the Mount Sinai School of Medicine in
Brooklyn list a classification system of medications in their 2007 report.
They have five categories: : Ia, Ib, II, III, and IV.

Class Ia drugs include one case report, evidence of a positive
rechallenge, and exclusion of other causes of acute pancreatitis. Class
Ib resembles class Ia, but in this class, other causes of acute
pancreatitis can not be ruled out. Class II drugs include at least four
case reports with a consistent latency period for at least 75% of the
cases. Class III drugs have at least two case reports but don’t contain
rechallenge data or a consistent latency period. Class IV drugs have
one case report without rechallenge data.

The following are meds that you want to look out for.


Diuretics have their primary use and are also employed to treat high
blood pressure.

The two main types of diuretics are furosemide (a class Ia agent) and
thiazide (class II and III agents).

A 1978 report studied furosemide and thiazide diuretics against
controls, and observed that patients taking diuretics were 2.5 times
more likely to develop chronic pancreatitis. Most of these were taking

However, a newer 2006 report by I.A. Eland from the Department of
Internal Medicine in The Netherlands provided dissenting information.
They didn’t find an increased risk with thiazide diuretics, but did find a
slight risk with other kinds.

The mechanism of diuretics on the pancreas is generally a direct toxic
effect to the pancreas, with a diuretic induced stimulation of pancreatic

Statins (AKA HMG-COA reductase inhibitors)

Statins are a category of drugs that serve to reduce the levels of fat in
your system, including triglycerides and cholesterol. They also serve to  
lower blood pressure.

In 2006, H. Thisted and researchers from the Aarhus University
hospital in Aarhus, Denmark, examined the correlation between statin
drugs and acute pancreatitis.

They observed 2,576 people admitted to the hospital for acute
pancreatitis and 25,817 matched controls.

Those with acute pancreatitis were divided into 5 categories: ever
before users, current users that filled a prescription within 90 days of
diagnosis, new users that filled a prescription within 90 days of
diagnosis, and former users that had not filled a prescription within
more than 90 days of their diagnosis.

Acute pancreatitis was induced in 3.9% of users and 2.9% of controls.
Increased risk was NOT noted in new users.

Statins are still a relative mystery as they appear to be dose dependent
but also unpredictable. Acute pancreatitis has been observed in both
cases of hours and years after initiation of therapy.

Statins could be classified as type Ia, Ib, III, and IV, according to
Badalov and colleagues.

Oral Contraception and Hormone Replacement Therapy (HRT)

In these cases, we are looking at the hormone estrogen.

There have been inconclusive results as far as these go, but enough
reported cases to warrant concern.

In a 2007 Danish study, researchers examined 1054 former and
current users of hormone replacement therapy in postmenopausal
women and 10,540 population controls. The cases were individuals
over 45 with a first time hospital discharge for acute pancreatitis.

M.S. Tetsche and other researchers from the Aarhus University Hospital
in Denmark found that there were non significant results in former
users of combined estrogen and progestin hormone replacement
therapy. There was an increased risk in current users, which may have
been due to the discontinuation of hormone replacement therapy,
leading to hypertriglyceridemia.

There have been reports of higher blood pressure due to oral
contraception and hormone therapy, including a 2017 report by
professor Jan Basile from the Medical University of South Carolina.

Valproic Acid

Valproic acid is an anticonvulsant used in the treatment of epilepsy.
While this is the primary use, the medicine has also been shown to be

While the drug has had mixed reports in the general population,
valproic acid tends to have a high incidence in the pediatric population
of about 13%.

Correlation of valproic acid in general, however, has had mixed results.
In a 2002 study, J.M. Pollock and professionals from the Medical
College of Virginia Hospitals in Richmond, Virginia, studied 3007
patients. Only 0.2% of them developed acute pancreatitis (and many
had other risk factors).

However, a different German study conducted by T. Gerstner at the
University Children’s Hospital in 2007 revealed documented cases of
Valproic acid induced acute pancreatic cases over ten years.

Generally, if acute pancreatitis occurs due to taking valproic acid, the
event will happen within the first year.

The mechanism occurs when there is a direct release of the toxic effect
of free radicals on pancreatic tissues.

HAART Therapy (HIV antiretroviral therapy)

Sometimes the cause and effect on this one is a little subjective,
because patients with HIV are already 35 to 800% more likely to
develop acute pancreatitis than the general population.
However, many reports do back up statistically significant incidence of
acute pancreatitis due to  HIV medications.

One such report, performed by J.J. Guo in 2005 at the University
Medical Center in Cincinnati, Ohio, analyzed 4,972 patients. 3.2% of
them developed acute pancreatitis.

The mechanism here may simply be the HIV infection itself, which does
cause direct pancreas inflammation. However, metabolic disturbances
caused by the medication could lead to the development of insulin


Blood pressure medications (as well as other varieties) does have the
potential to attack the pancreas, depending on how your system is
already functioning and how your body reacts.

Weighing the costs and benefits of trying these medications is key.
Also, be sure to ask your doctor for specific recommendations for the
safest products possible.

As with any medications, you’ll want to research the contraindications
for other conditions you may already have or might develop.

There are still many mixed reports on blood pressure and other
medications, so being cautious is the best bet.  

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Certain high blood pressure medications
increase your risk fro diabetes.