Methotrexate, often abbreviated as MTX, is a prescription medication primarily known for its role in treating various autoimmune conditions and certain types of cancer. For autoimmune diseases, it functions by reducing the immune system’s overactivity, thereby decreasing inflammation that can lead to pain, swelling, and long-term tissue damage. Conditions such as rheumatoid arthritis, psoriasis, and psoriatic arthritis commonly benefit from methotrexate treatment. In cancer therapy, methotrexate is used at much higher doses to slow the growth of cancer cells, including those in leukemias, lymphomas, and breast cancer.
Does Methotrexate Directly Cause High Blood Pressure?
Methotrexate is not typically identified as a direct or common cause of high blood pressure (hypertension) in most patients. Medical literature does not widely support a direct causal link between methotrexate and hypertension as a frequent side effect. Some studies suggest methotrexate might have a neutral or even beneficial effect on blood pressure, particularly in patients with inflammatory conditions.
Observational studies in individuals with rheumatoid arthritis have shown that patients receiving methotrexate may exhibit lower blood pressure compared to those on other anti-rheumatic drugs. Proving a direct blood pressure-reducing effect in these studies has been challenging. A randomized, placebo-controlled trial involving patients with cardiovascular risk but without rheumatic disease found no clinically meaningful difference in blood pressure between those taking low-dose methotrexate and those on a placebo. This suggests observed blood pressure changes are likely due to other factors or individual responses, not a direct universal effect of the drug.
Potential Indirect Links and Contributing Factors
While methotrexate does not directly cause high blood pressure, several indirect associations and contributing factors can influence blood pressure in patients undergoing treatment. The underlying chronic inflammatory diseases that methotrexate treats, such as rheumatoid arthritis and psoriasis, are independently associated with an increased risk of cardiovascular issues, including hypertension. Inflammation itself can damage blood vessels and contribute to elevated blood pressure.
Kidney function also plays a role, as methotrexate is primarily eliminated through the kidneys. Impaired kidney function, which can be a concern with long-term methotrexate use, can lead to high blood pressure. Regular monitoring of kidney function is therefore important during methotrexate therapy.
Concomitant medications frequently taken by patients on methotrexate can also elevate blood pressure. Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, often used for pain and inflammation in autoimmune diseases, are known to increase blood pressure.
Paradoxically, by effectively reducing inflammation, methotrexate may actually offer cardiovascular benefits. Studies have indicated that methotrexate is associated with improved endothelial function, slower progression of atherosclerosis, and a decreased risk of major cardiovascular events in patients with immune-mediated inflammatory diseases. These protective effects stem from its anti-inflammatory and immunosuppressive actions, mitigating systemic inflammation that contributes to cardiovascular disease.
Monitoring and Managing Blood Pressure While on Methotrexate
Patients taking methotrexate should prioritize regular monitoring of their blood pressure, both at home and during routine medical appointments. Open communication with healthcare providers about any blood pressure readings or other health changes is important. This helps identify and address potential issues promptly.
Adherence to the prescribed methotrexate dosage and schedule is crucial for effective treatment and minimizing potential complications. Attending all scheduled follow-up appointments and laboratory tests, particularly those assessing kidney and liver function, allows the healthcare team to monitor the medication’s effects and make necessary adjustments.
Incorporating healthy lifestyle habits can also support healthy blood pressure levels while on methotrexate. This includes a balanced diet, regular physical activity, maintaining a healthy weight, and limiting sodium intake. Patients should never alter their methotrexate dosage or discontinue the medication without consulting their doctor, as this could compromise treatment and overall health.