Proton pump inhibitors: lower acid, raise blood pressure?

Proton pump inhibitors such as pantoprazole and omeprazole are among the most commonly prescribed drugs in Germany. They inhibit the proton pump in the stomach, halting acid secretion, which is beneficial in cases of gastric or duodenal ulcers or existing risk factors for them. However, due to potential side effects such as osteoporosis and Clostridioides difficile infections, gastroenterologists urge that PPIs be used only strictly for their intended purpose and, in particular, that long-term use be regularly reviewed.

This is also supported by the results of a retrospective observational study recently published in the Journal of the American Heart Association . A team of authors led by Dr. Ahmed I. Soliman from the University at Buffalo in New York State link the use of PPIs with an increased risk of hypertension in postmenopausal women. Women in connection.

The study is based on the idea that an acidic gastric pH is necessary to convert nitrite (NO ₂ ^- ) ingested with food into nitric oxide (NO). The latter is a potent vasodilator and blood pressure reducer that is also used therapeutically . Studies have shown that the so-called nitrate-nitrite-NO pathway is involved in blood pressure regulation, the authors write. Initial results also indicate that the use of PPIs via this same pathway could increase blood pressure .

The team then examined this association in a large cohort consisting of participants in the observational arm of the Women's Health Initiative (WHI). A total of 64,720 women between the ages of 50 and 79 who had not initially had hypertension participated. Within an average follow-up period of 8.7 years, 28,951 women had developed medically diagnosed hypertension according to self-report. Using statistical methods, the authors calculated the relative risk of developing hypertension depending on PPI use, taking into account various demographic, lifestyle, and clinical factors.