Cutaneous effects of antihypertensive drugs: A comprehensive narrative review of side effects, management, and prevention.

Abstract

Hypertension, a major global health burden affecting over one billion people worldwide, is primarily managed with pharmacological therapy. While effective for cardiovascular protection, antihypertensive drugs can cause under-recognized cutaneous adverse drug reactions (CADRs). This review summarizes CADRs associated with antihypertensive medications, including pathophysiology, clinical presentation, diagnosis, management, and prevention. A narrative review of PubMed (January 2001-August 2025) was conducted to identify studies on CADRs linked to antihypertensive therapy, and observational studies, case reports, case series, and clinical trials were included. CADRs arise through immunologic (Types I-IV hypersensitivity, most often Type IV) and non-immunologic mechanisms. Clinical presentations range from mild eruptions (maculopapular rash, photosensitivity, urticaria) to severe reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Symptoms usually occur within weeks of initiation, though delayed reactions are possible. Diagnosis relies on detailed medication history, examination, and, in selected cases, histopathology, and resolution after drug withdrawal is a key diagnostic clue. Management involves discontinuing the offending agent, supportive care, and pharmacological interventions (e.g. corticosteroids, antihistamines). Preventive strategies include avoidance of reexposure, substitution with safer alternatives, and strict photoprotection. Antihypertensive medications can cause diverse CADRs with variable severity and clinical impact, and early recognition and prompt management are essential to minimize morbidity. Prospective studies with standardized definitions and pharmacogenomic approaches are needed to improve risk prediction and guide safer, individualized prescribing.