A 77 year old female presented to her primary care physician for a routine follow-up. She had no complaints and stated that she felt well. Her blood pressure (BP) was found to be 224/90 and repeat checks confirmed it. She has history of hypertension, which has been controlled with Lisinopril 5 mg and Amlodipine 5 mg. Her baseline BP readings were 140’s/70’s range. She denied any vision changes, headaches, lightheadedness, chest pain, or palpitations. She does not have any significant cardiac or renal history. Her only other medical problems are osteopenia and marijuana abuse. In view of elevated BP, 220/90, during her previous visit 1 week ago, her dose of Lisinopril 5 mg and Amlodipine 5 mg were adjusted to Lisinopril 20 mg and amlodipine 10 mg. However at the return visit in one week, her BP remained in the 220’s/90’s. Upon further questioning, patient revealed that she had been a chronic marijuana user for many years and smoked about 4 “joints” per day. She stated that she has recently been trying to cut down and now only smokes 1 “joint” per week and her last use of marijuana was prior to both appointments.
Marijuana is one of the most highly abused illicit drugs since it is easily obtained and is legal in many parts of the world. Studies have shown that acute ingestion of cannabis initially causes an increase in BP, but with chronic heavy use, tolerance develops and actually causes a decrease in BP. Recent studies have demonstrated that daily cannabis abusers face withdrawal symptoms, one of which is a significant increase in BP. One study showed a mean increase of up to 22.8 mmHg systolic and 12.3 mmHg diastolic BP during periods of abstinence and withdrawal. It is very likely that our patient may have developed hypertensive urgency secondary to cannabis withdrawal.
Our case illustrates that abrupt cessation of cannabis in a chronic heavy user may cause a significant rise in blood pressure. This may even lead to hypertensive urgency or emergency in patients with preexisting hypertension. It may also be very difficult to control, as our patient did not respond to increased doses of Lisinopril and Amlodipine. A clinician should always look for possible causes of uncontrolled hypertension, and must keep in mind that social history can be crucial, which is often overlooked. It is also important to monitor closely the blood pressure of chronic marijuana abusers who are trying to quit or cut down.