The blood pressure elevation is unrelated to venlafaxine, so refer to cardiology for a primary hypertension workup.

New-onset hypertension in a patient on high-dose venlafaxine should prompt assessment of medication causality before referral to cardiology.

Add an antihypertensive medication to manage the elevated blood pressure while continuing venlafaxine at the current dose unchanged.

Adding an antihypertensive without addressing the medication cause is treating the symptom rather than the etiology.

Assess for venlafaxine-induced hypertension, as SNRIs cause dose-dependent norepinephrine-mediated blood pressure elevation at higher doses.

Venlafaxine causes dose-dependent blood pressure elevation through norepinephrine reuptake inhibition. At doses ≥225 mg, dose-dependent blood pressure elevation is a well-documented effect. The temporal relationship between dose increase and blood pressure elevation is the key assessment. If confirmed, options include dose reduction, switching to an antidepressant without this effect (SSRI, bupropion, mirtazapine), or continuing with blood pressure monitoring and antihypertensive treatment if the psychiatric benefit is substantial.

Reduce venlafaxine to 150 mg immediately without a taper schedule to quickly lower the noradrenergic effect on blood pressure.

Venlafaxine should not be abruptly reduced due to significant discontinuation syndrome risk. Any dose change requires gradual tapering.