Journal Article

Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension

Hansen, Richard A, Aljadhey, Hisham, Brater, D Craig, Tu, Wanzhu, Murray, Michael D, Blalock, Susan J

2012

Overview

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension. Methods We conducted a retrospective cohort study of adult hypertensive patients to determine the effects of their first prescription for NSAID on systolic blood pressure and antihypertensive drug intensification. Data were collected from an electronic medical record serving an academic general medicine practice in Indianapolis, Indiana, USA. Using propensity scores to minimize bias, we matched a cohort of 1,340 users of NSAIDs with 1,340 users of acetaminophen. Propensity score models included covariates likely to affect blood pressure or the use of NSAIDs. The study outcomes were the mean systolic blood pressure measurement after starting NSAIDs and changes in antihypertensive therapy. Results Compared to patients using acetaminophen, NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10). The systolic blood pressure increase was 3 mmHg in a subgroup of patients concomitantly prescribed angiotensin converting enzyme inhibitors or calcium channel blockers and 6 mmHg among those prescribed a beta-adrenergic blocker. Blood pressure changes in patients prescribed diuretics or multiple antihypertensives were not statistically significant. Conclusion Compared to acetaminophen, incident use of NSAIDs, particularly ibuprofen, is associated with a small increase in systolic blood pressure in hypertensive patients. Effects in patients prescribed diuretics or multiple antihypertensives are negligible.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acetaminophen / Acetaminophen - therapeutic use / Analgesics, Non-Narcotic - adverse effects / Analgesics, Non-Narcotic - therapeutic use / Angiology / Angiotensin converting enzyme / Anti-Inflammatory Agents, Non-Steroidal - adverse effects / Anti-Inflammatory Agents, Non-Steroidal - therapeutic use / Antihypertensive Agents - therapeutic use / Antihypertensive drugs / Blood pressure / Blood Pressure - drug effects / Blood Transfusion Medicine / Calcium channels / Cardiac Surgery / Cardiology / Cardiovascular disease / Care and treatment / Celecoxib / Comparative analysis / Diuretics / Drug Interactions / Drug therapy / Enzyme inhibitors / Female / Health aspects / Humans / Hypertension / Hypertension - diagnosis / Hypertension - drug therapy / Hypertension - physiopathology / Hypertension and Cardiovascular Risk / Ibuprofen / Ibuprofen - therapeutic use / Indiana / Internal Medicine / Linear Models / Male / Measurement / Medical records / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Naproxen - therapeutic use / Nonsteroidal anti-inflammatory drugs / NSAIDs / Odds Ratio / Propensity Score / Pyrazoles - therapeutic use / Research Article / Retrospective Studies / Risk Assessment / Risk Factors / Studies / Sulfonamides - therapeutic use / Treatment Outcome