Advertisement

Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study

Published:January 20, 2021DOI:https://doi.org/10.1016/j.ejim.2021.01.005

      Abstract

      Background: Medical cannabis use is increasing rapidly in the past several years, with older adults being the fastest growing group. Nevertheless, the evidence for cardiovascular safety of cannabis use is scarce. The aim of this study was to assess the effect of cannabis on blood pressure, heart rate, and metabolic parameters in older adults with hypertension.
      Methods: We conducted a prospective study of patients aged 60 years or more with hypertension and a new prescription of cannabis. We have performed the following assessments: 24-hours ambulatory blood pressure monitoring, ECG, blood tests, and anthropometric measurements prior to the initiation of cannabis therapy and 3 months afterward. The primary outcome was change in mean 24-h blood pressure at 3 months.
      Results: Twenty-six patients with a mean age of 70.42 ± 5.37 years, 53.8% females completed the study. At 3 months follow-up, the mean 24-hours systolic and diastolic blood pressures were reduced by 5.0 mmHg and 4.5 mmHg, respectively (p<0.001 for both). The nadir for the blood pressure and heart rate was achieved at 3 hours post-administration. The proportion of normal dippers changed from 27.3% before treatment to 45.5% afterward. No significant changes were seen in the different metabolic parameters assessed by blood tests, anthropometric measurements, or ECG exam.
      Conclusion: amongst older adults with hypertension, cannabis treatment for 3 months was associated with a reduction in 24-hours systolic and diastolic blood pressure values with a nadir at 3 hours after cannabis administration.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Park JY
        • Wu LT.
        Prevalence, reasons, perceived effects, and correlates of medical marijuana use: A review.
        Drug Alcohol Depend. 2017; 177: 1-13https://doi.org/10.1016/j.drugalcdep.2017.03.009
        • Fairman BJ.
        Trends in registered medical marijuana participation across 13 US states and District of Columbia.
        Drug Alcohol Depend. 2016; 159: 72-79https://doi.org/10.1016/j.drugalcdep.2015.11.015
        • Hamilton HA
        • Brands B
        • Ialomiteanu AR
        • Mann RE.
        Therapeutic use of cannabis: Prevalence and characteristics among adults in Ontario.
        Canada. Can J Public Heal. 2017; 108: e282-e287https://doi.org/10.17269/cjph.108.6130
        • Whiting PF
        • Wolff RF
        • Deshpande S
        • Di Nisio M
        • Duffy S
        • Hernandez AV
        • et al.
        Cannabinoids for Medical Use.
        JAMA. 2015; 313: 2456-2473https://doi.org/10.1001/jama.2015.6358
        • Lim K
        • See YM
        • Lee J.
        A systematic review of the effectiveness of medical cannabis for psychiatric, movement and neurodegenerative disorders.
        Clin Psychopharmacol Neurosci. 2017; 15: 301-312https://doi.org/10.9758/cpn.2017.15.4.301
        • Friedman D
        • Devinsky O.
        Cannabinoids in the Treatment of Epilepsy.
        N Engl J Med. 2015; 373: 1048-1058https://doi.org/10.1056/NEJMra1407304
        • Han BH
        • Palamar JJ.
        Trends in Cannabis Use among Older Adults in the United States, 2015-2018.
        JAMA Intern Med. 2020; 180: 609-611https://doi.org/10.1001/jamainternmed.2019.7517
        • Baumbusch J
        • Sloan Yip I
        Exploring New Use of Cannabis among Older Adults.
        Clin Gerontol. 2020; https://doi.org/10.1080/07317115.2020.1746720
        • Azofeifa A
        • Mattson ME
        • Schauer G
        • McAfee T
        • Grant A
        • Lyerla R.
        National estimates of marijuana use and related indicators - National Survey on Drug Use and Health, United States, 2002-2014.
        MMWR Surveill Summ. 2016; 65: 1-25https://doi.org/10.15585/mmwr.ss6511a1
        • Hazekamp A
        • Heerdink ER.
        The prevalence and incidence of medicinal cannabis on prescription in the Netherlands.
        Eur J Clin Pharmacol. 2013; 69: 1575-1580https://doi.org/10.1007/s00228-013-1503-y
        • Kaskie B
        • Ayyagari P
        • Milavetz G
        • Shane D
        • Arora K.
        The Increasing Use of Cannabis among Older Americans: A Public Health Crisis or Viable Policy Alternative?.
        Gerontologist. 2017; 57: 1166-1172https://doi.org/10.1093/geront/gnw166
        • Hazekamp A
        • Ware MA
        • Muller-Vahl KR
        • Abrams D
        • Grotenhermen F.
        The Medicinal Use of Cannabis and Cannabinoids-An International Cross-Sectional Survey on Administration Forms.
        J Psychoactive Drugs. 2013; 45: 199-210https://doi.org/10.1080/02791072.2013.805976
        • Abuhasira R
        • Ron A
        • Sikorin I
        • Novack V
        Medical Cannabis for Older Patients—Treatment Protocol and Initial Results.
        J Clin Med. 2019; 8: 1819https://doi.org/10.3390/jcm8111819
        • Bar-Lev Schleider L
        • Abuhasira R
        • Novack V.
        Medical cannabis: aligning use to evidence-based medicine approach.
        Br J Clin Pharmacol. 2018; 84: 2458-2462https://doi.org/10.1111/bcp.13657
        • Page RL
        • Allen LA
        • Kloner RA
        • Carriker CR
        • Martel C
        • Morris AA
        • et al.
        Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association.
        Circulation, 2020https://doi.org/10.1161/CIR.0000000000000883
        • Van Den Elsen GAH
        • Ahmed AIA
        • Verkes RJ
        • Feuth T
        • Van Der Marck MA
        • Olde Rikkert MGM
        Tetrahydrocannabinol in Behavioral Disturbances in Dementia: A Crossover Randomized Controlled Trial.
        Am J Geriatr Psychiatry. 2015; 23: 1214-1224https://doi.org/10.1016/j.jagp.2015.07.011
        • van den Elsen GAH
        • Ahmed AIA
        • Verkes R-J
        • Kramers C
        • Feuth T
        • Rosenberg PB
        • et al.
        Tetrahydrocannabinol for neuropsychiatric symptoms in dementia: A randomized controlled trial.
        Neurology. 2015; 84: 2338-2346https://doi.org/10.1212/WNL.0000000000001675
        • Ahmed AIA
        • van den Elsen GAH
        • Colbers A
        • van der Marck MA
        • Burger DM
        • Feuth TB
        • et al.
        Safety and pharmacokinetics of oral delta-9-tetrahydrocannabinol in healthy older subjects: A randomized controlled trial.
        Eur Neuropsychopharmacol. 2014; 24: 1475-1482https://doi.org/10.1016/j.euroneuro.2014.06.007
        • Kariyanna PT
        • Wengrofsky P
        • Jayarangaiah A
        • Haseeb S
        • Salciccioli L
        • Hegde S
        • et al.
        Marijuana and Cardiac Arrhythmias: A Scoping Study.
        Int J Clin Res Trials. 2019; : 4https://doi.org/10.15344/2456-8007/2019/132
        • Richards JR
        • Blohm E
        • Toles KA
        • Jarman AF
        • Ely DF
        • Elder JW.
        The association of cannabis use and cardiac dysrhythmias: a systematic review.
        Clin Toxicol. 2020; : 1-9https://doi.org/10.1080/15563650.2020.1743847
        • Korantzopoulos P
        • Liu T
        • Papaioannides D
        • Li G
        • Goudevenos JA.
        Atrial fibrillation and marijuana smoking.
        Int J Clin Pract. 2008; 62: 308-313https://doi.org/10.1111/j.1742-1241.2007.01505.x
        • Abuhasira R
        • Novack V.
        Increased risk of cardiac arrhythmias with cannabis use – more studies are needed.
        Eur J Intern Med. 2020; https://doi.org/10.1016/j.ejim.2020.08.008
        • Von Elm E
        • Altman DG
        • Egger M
        • Pocock SJ
        • Gøtzsche PC
        • Vandenbroucke JP.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        BMJ. 2007; 335: 806-808https://doi.org/10.1136/bmj.39335.541782.ad
        • Abuhasira R
        • Shbiro L
        • Landschaft Y.
        Medical use of cannabis and cannabinoids containing products – regulations in Europe and North America.
        Eur J Intern Med. 2018; 49: 2-6https://doi.org/10.1016/j.ejim.2018.01.001
      1. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels.
        9th ed. Boston, Mass: Little, Brown & Co1994
        • Goodwin J
        • Bilous M
        • Winship S
        • Finn P
        • Jones SC.
        Validation of the Oscar 2 oscillometric 24-h ambulatory blood pressure monitor according to the British Hypertension Society protocol.
        Blood Press Monit. 2007; 12: 113-117https://doi.org/10.1097/MBP.0b013e3280acab1b
        • Jones SC
        • Bilous M
        • Winship S
        • Finn P
        • Goodwin J.
        Validation of the OSCAR 2 oscillometric 24-hour ambulatory blood pressure monitor according to the International Protocol for the validation of blood pressure measuring devices.
        Blood Press Monit. 2004; 9: 219-223https://doi.org/10.1097/00126097-200408000-00007
        • Parati G
        • Stergiou G
        • O'Brien E
        • Asmar R
        • Beilin L
        • Bilo G
        • et al.
        European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.
        J Hypertens. 2014; 32: 1359-1366https://doi.org/10.1097/HJH.0000000000000221
        • O'Brien E
        • Parati G
        • Stergiou G
        • Asmar R
        • Beilin L
        • Bilo G
        • et al.
        European society of hypertension position paper on ambulatory blood pressure monitoring.
        J Hypertens. 2013; 31: 1731-1768https://doi.org/10.1097/HJH.0b013e328363e964
        • Israeli Medical Cannabis Agency
        Information booklet and medical guide IMC-GCP sub-circular to the Israeli Ministry of Health Director Hebrew only. 2019; (accessed April 15, 2020)
        • Huestis MA
        Human cannabinoid pharmacokinetics.
        Chem Biodivers. 2007; 4: 1770-1804https://doi.org/10.1002/cbdv.200790152
        • Grotenhermen F.
        Pharmacokinetics and pharmacodynamics of cannabinoids.
        Clin Pharmacokinet. 2003; 42: 327-360https://doi.org/10.2165/00003088-200342040-00003
        • Staessen Jan A.
        • Thijs Lutgarde
        • Fagard Robert
        • O'Brien Eoin T.
        • Clement Denis
        • Leeuw Peter W.de
        • Mancia Giuseppe
        • Nachev Choudomir
        • Palatini Paolo
        • Parati Gianfranco
        • Tuomilehto Jaakko
        John webster M for the SH in ETI. predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension.
        JAMA. 1999; : 282:539https://doi.org/10.1001/jama.282.6.539
        • Ahmed AIA
        • van den Elsen GAH
        • Colbers A
        • Kramers C
        • Burger DM
        • van der Marck MA
        • et al.
        Safety, pharmacodynamics, and pharmacokinetics of multiple oral doses of delta-9-tetrahydrocannabinol in older persons with dementia.
        Psychopharmacology (Berl). 2015; 232: 2587-2595https://doi.org/10.1007/s00213-015-3889-y
        • Ponto LLB
        • O'Leary DS
        • Koeppel J
        • Block RI
        • Watkins GL
        • Richmond JCW
        • et al.
        Effect of acute marijuana on cardiovascular function and central nervous system pharmacokinetics of [15o]water: effect in occasional and chronic users.
        J Clin Pharmacol. 2004; 44: 751-766https://doi.org/10.1177/0091270004265699
        • Jouanjus E
        • Raymond V
        • Lapeyre-Mestre M
        • Wolff V.
        What is the current knowledge about the cardiovascular risk for users of cannabis-based products? a systematic review.
        Curr Atheroscler Rep. 2017; : 19:26https://doi.org/10.1007/s11883-017-0663-0
        • Kayser RR
        • Haney M
        • Raskin M
        • Arout C
        • Simpson HB.
        Acute effects of cannabinoids on symptoms of obsessive-compulsive disorder: A human laboratory study.
        Depress Anxiety. 2020; (da.23032)https://doi.org/10.1002/da.23032
        • Karschner EL
        • Darwin WD
        • McMahon RP
        • Liu F
        • Wright S
        • Goodwin RS
        • et al.
        Subjective and physiological effects after controlled Sativex and oral THC administration.
        Clin Pharmacol Ther. 2011; 89: 400-407https://doi.org/10.1038/clpt.2010.318
        • Verdecchia P
        • Gentile G
        • Angeli F
        • Mazzotta G
        • Mancia G
        • Reboldi G.
        Influence of blood pressure reduction on composite cardiovascular endpoints in clinical trials.
        J Hypertens. 2010; 28: 1356-1365https://doi.org/10.1097/HJH.0b013e328338e2bb
        • Latif Z
        • Garg N.
        The impact of marijuana on the cardiovascular system: a review of the most common cardiovascular events associated with marijuana use.
        J Clin Med. 2020; 9: 1925https://doi.org/10.3390/jcm9061925
        • Bruehl S
        • Olsen RB
        • Tronstad C
        • Sevre K
        • Burns JW
        • Schirmer H
        • et al.
        Chronic pain-related changes in cardiovascular regulation and impact on comorbid hypertension in a general population: The Tromsø study.
        Pain. 2018; 159: 119-127https://doi.org/10.1097/j.pain.0000000000001070
        • Mangoni AA JS
        Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications.
        Br J Clin Pharmacol. 2003; 57: 6-14https://doi.org/10.1046/j.1365-2125.2003.02007.x
        • DeFilippis EM
        • Bajaj NS
        • Singh A
        • Malloy R
        • Givertz MM
        • Blankstein R
        • et al.
        Marijuana Use in Patients With Cardiovascular Disease.
        J Am Coll Cardiol. 2020; 75: 320-332https://doi.org/10.1016/j.jacc.2019.11.025
        • Singh A
        • Saluja S
        • Kumar A
        • Agrawal S
        • Thind M
        • Nanda S
        • et al.
        Cardiovascular Complications of Marijuana and Related Substances: A Review.
        Cardiol Ther, 2017https://doi.org/10.1007/s40119-017-0102-x
        • Sidney S.
        Cardiovascular consequences of marijuana use.
        J Clin Pharmacol. 2002; 42 (64S–70S)https://doi.org/10.1002/j.1552-4604.2002.tb06005.x
        • Abuhasira R
        • Schleider LBL
        • Mechoulam R
        • Novack V.
        Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly.
        Eur J Intern Med. 2018; 49: 44-50https://doi.org/10.1016/j.ejim.2018.01.019
        • Mathew RJ
        • Wilson WH
        • Humphreys D
        • Lowe JV.
        • Wiethe KE.
        Middle cerebral artery velocity during upright posture after marijuana smoking.
        Acta Psychiatr Scand. 1992; 86: 173-178https://doi.org/10.1111/j.1600-0447.1992.tb03247.x
        • Diederichsen SZ
        • Haugan KJ
        • Kronborg C
        • Graff C
        • Højberg S
        • Køber L
        • et al.
        Comprehensive evaluation of rhythm monitoring strategies in screening for atrial fibrillation: insights from patients at risk monitored long term with an implantable loop recorder.
        Circulation. 2020; 141 (10.1161/CIRCULATIONAHA.119.044407): 1510-1522
        • Meier MH
        • Pardini D
        • Beardslee J
        • Matthews KA.
        Associations between cannabis use and cardiometabolic risk factors.
        Psychosom Med. 2018; (10.1097/PSY.0000000000000665): 1
        • Penner EA
        • Buettner H
        • Mittleman MA.
        The impact of marijuana use on glucose, insulin, and insulin resistance among US adults.
        Am J Med. 2013; 126: 583-589https://doi.org/10.1016/J.AMJMED.2013.03.002
        • Rajavashisth TB
        • Shaheen M
        • Norris KC
        • Pan D
        • Sinha SK
        • Ortega J
        • et al.
        Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III.
        BMJ Open. 2012; 2e000494https://doi.org/10.1136/bmjopen-2011-000494
        • Lazarte J
        • Hegele RA.
        Cannabis effects on lipoproteins.
        Curr Opin Lipidol. 2019; 30 (10.1097/MOL.0000000000000575): 140-146