Antihypertensive Medications Inducing Salivary Gland Dysfunction and Xerostomia: A Narrative Review

The aim of this study was to review the literature on the relationship between antihypertensive drugs and reduced salivary flow (hyposalivation) and the sensation of dry mouth (xerostomia). An exhaustive search of the literature was carried out, with no prior date limit until 31 August 2022, on PubMed, Google scholar and the Cochrane Library. The search terms were: saliva, xerostomia, hyposalivation OR salivary flow AND hypertension, antihypertensive drug, OR antihypertensive drugs. The overall prevalence of xerostomia in this population of hypertensive patients on pharmacological treatment was 21.1%. For the relationship between antihypertensive drugs and salivary secretion, the type of antihypertensive studied in the literature included β-adrenergic blockers, diuretics, α-adrenergic blockers, calcium channel blockers and cardiac glycosides. In some studies, the type of antihypertensive was not available. Many studies measured unstimulated salivary flow to assess hyposalivation. Three studies showed a non-significant increase in unstimulated salivary flow after treatment with β-adrenergic blockers or angiotensin converting enzyme (ACE) inhibitors. One study found a statistically significant decrease in unstimulated salivary flow in normotensives treated with propranolol and phentolamine, which are both non-selective β-blockers. Two studies showed no significant decrease in unstimulated salivary flow after treatment with diuretics. For stimulated salivary flow, one study had no significant changes in patients treated with captopril (ACE inhibitor) and two others had a significant decrease after treatment with furosemide and bendroflumethiazide (two diuretics). A single study shows that the percentage of patients with hyposalivation was significantly higher in hypertensive patients treated with ACE inhibitors, calcium channel blockers, β-adrenergic blockers, and diuretics. Future studies are needed and may help to understand which antihypertensive is most appropriate for patients to avoid reduced salivary flow and dry mouth.