Do Benzodiazepines Like Xanax and Ativan Lower Blood Pressure?

What the Studies Measured

The clearest numbers come from people taking a benzodiazepine for months or years. An Australian study of 523,486 general practice patients found that long-term users 65 and older had systolic pressure (the top number) about 2.5 mmHg lower and diastolic pressure (the bottom number) about 1 mmHg lower than similar patients not taking one. Younger long-term users showed almost no effect, and people on a short course had readings that were very slightly higher, not lower (Begum et al., 2023). An Israeli analysis of 4,938 twenty-four-hour blood pressure recordings found the same pattern: regular users 60 and older ran lower around the clock, by about 2 points systolic in the adjusted results, and younger users showed no clear difference (Mendelson et al., 2018). An editorial published with that study pointed out that the younger group was too small to settle the question either way (Colussi et al., 2018).

The short-term evidence is thinner. A 2023 review pooled seven studies in people with high blood pressure and found benzodiazepines lowered it about as much as standard blood pressure medicines over the short term, but the difference from placebo in systolic pressure was not statistically significant, and the authors called the evidence preliminary (Solanki et al., 2023). Other studies point the other way. In a small randomized trial, two weeks of alprazolam or lorazepam at bedtime did not change twenty-four-hour blood pressure in people with mild hypertension (Costa et al., 2021), and in a Belgian study of 1,272 people with insomnia, long-term use of shorter-acting sleep medicines in this family went with a higher chance of high blood pressure (Hein et al., 2019).

Put together: where these medicines lower blood pressure, the drop is small, and it is not consistent from one study to the next. The editorial that accompanied the Israeli study concluded that using them to treat ongoing high blood pressure is not advisable at any age.

Why Calm Can Show Up on the Cuff

Benzodiazepines strengthen the effect of GABA, the brain's main calming chemical messenger (NIDA). That turns down the "fight or flight" drive that tightens blood vessels and speeds the heart, and some benzodiazepines also relax blood vessels directly (Colussi et al., 2018). The ones people ask about most are alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium).

The drug labels describe the effect as modest. The prescribing information for Ativan says small decreases in blood pressure "may occur but are usually not clinically significant, probably being related to the relief of anxiety" (FDA label, Ativan). In Xanax's trials for generalized anxiety, low blood pressure was reported by 5% of people taking it and 2% taking a placebo (FDA label, Xanax). By the label's own explanation, part of what shows on the cuff is the anxiety easing.

Standing Up Is Where the Drop Matters

An average of 2 or 3 points says little about the moment that causes trouble. In a study of 538 people aged 60 and older, those who took a benzodiazepine regularly had lower resting systolic pressure (149 against 161 mmHg) and a bigger drop in the first seconds after standing, even after accounting for their blood pressure medicines and other health conditions (Rivasi et al., 2019). A brief dip like that is what can make someone lightheaded getting out of a chair or out of bed.

It is also one reason benzodiazepines are linked with falls in older adults. A review of studies in people 60 and older found benzodiazepine use was linked with about 42% higher odds of falling (Seppala et al., 2018), and a clinical review lists low blood pressure on standing alongside dizziness, sedation and muscle weakness as the ways these medicines contribute (Capiau et al., 2022). Older adults also clear these drugs more slowly, so the effect can build (Vozoris et al., 2013).

When Other Medicines or Alcohol Are in the Mix

Blood pressure medicines and benzodiazepines lower pressure in different ways, and a large review of drug-related drops on standing concluded that medicines acting on different parts of the body's standing reflex may add up (Bhanu et al., 2021). Alcohol adds to the same effects: the National Institute on Alcohol Abuse and Alcoholism lists drowsiness and dizziness for alcohol with Ativan, Klonopin, Valium or Xanax, and dizziness and fainting for alcohol with blood pressure medicines (NIAAA).

With opioids and other sedatives, blood pressure stops being the main concern. Both opioids and benzodiazepines can sedate and suppress breathing, and in 2021 nearly 14% of overdose deaths involving opioids also involved benzodiazepines (NIDA). That danger is covered in more detail in how these medicines affect breathing.

What Stopping Does to Blood Pressure and Heart Rate

Withdrawal can push the numbers the other way. The prescribing information for Xanax and Ativan, in wording shared across the class, lists high blood pressure and a fast heart rate among withdrawal signs, along with anxiety, insomnia, tremor and others (FDA labels, Xanax and Ativan). In data from 641 people treated with Xanax for panic disorder, 12.2% had a fast heart rate after it was stopped. When the FDA reviewed withdrawal reports in 2020, it noted changes in heart rate or rhythm among them (FDA, 2020).

Withdrawal from a benzodiazepine can be serious, and an individualized medical plan may be needed. The FDA's 2020 boxed warning says physical dependence can develop "even as prescribed" when the medicine is taken steadily for several days to weeks, and that stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures. The FDA also says no single tapering schedule suits everyone. A 2025 guideline from the American Society of Addiction Medicine and nine other medical organizations advises clinicians not to stop benzodiazepines abruptly in people likely to be physically dependent, and to fit each taper to the person (Brunner et al., 2025). Blood pressure and heart rate are only part of the picture; the wider set of withdrawal symptoms is covered separately.

Signs That It Is More Than a Small Dip

A small, steady drop usually goes unnoticed. These are different, and they point to something more than the medicine's usual effect:

• fainting, or nearly fainting
• chest pain, or a racing or irregular heartbeat
• new confusion or extreme drowsiness
• severe withdrawal signs after a stop or a dose cut, such as seizures, hallucinations or delirium

The labels add one more point. In a benzodiazepine overdose, blood pressure, heart rate or breathing that is markedly high or low "raise the concern that additional drugs and/or alcohol are involved" (FDA labels, Xanax and Ativan).

When the Concern Is the Pattern of Use

Taking a prescribed benzodiazepine does not mean someone has a substance use disorder, and physical dependence is not the same as addiction. The worry is different when use has gone past the prescription, when doses are being taken with alcohol or opioids, or when attempts to cut back have not held. Guiding Road treats men whose substance use involves benzodiazepines, in residential care in Phoenix with step-down levels of care afterward. Detox is coordinated with medical partners rather than provided on site, and assessment looks at anxiety and other co-occurring concerns alongside substance use, which matters when anxiety is why the medicine was prescribed. You can read more about how Guiding Road treats benzodiazepine use.

If you are worried about a husband's, son's or father's benzodiazepine use, you can talk with admissions about his needs, the program and what to expect before making any decision. The admissions line is (480) 588-2328.