Nonsteroidal Anti-Inflammatory Drugs and Hypertension

Robert D. Brook, MD, Michael B. Kramer, Department of Internal Medicine, Division of Hypertension, University of Michigan Health Center; Burns C. Blaxall, PhD; Department of Experimental Surgery, Duke University Medical Center, Durham, NC; John D. Bisognano, MD, PhD Department of Internal Medicine, Divisions of Hypertension and Cardiology, University of Michigan Health Center, Ann Arbor, MI.

In This Article

Abstract and Introduction

Nonsteroidal anti-inflammatory drugs are among the most widely prescribed medications. Their effect on blood pressure has been monitored, and many small studies have determined a potential relationship between their use and elevation of blood pressure. These drugs may affect blood pressure by inhibiting prostaglandin synthesis, which may affect arteriolar smooth muscle tone and natriuresis. Since many patients with conditions such as osteoarthritis require treatment and also have hypertension, even modest elevations in blood pressure or inhibition of antihypertensive medication efficacy resulting from non steroidal anti-inflammatory drugs can be of significant clinical and public health importance. This review finds that certain drugs (e.g., indomethicin, piroxicam, and naproxen) may cause clinically relevant elevations in blood pressure in hypertensive patients. Aspirin and sulindac do not appear to elevate blood pressure significantly, even in hypertensive patients. Ibuprofen and other nonsteroidal anti-inflammatory drugs appear to have an intermediate blood pressure effect. Cyclo-oxygenase-2 inhibitors such as refecoxib and celecoxib have been shown to cause mild elevations in blood pressure, but further studies are needed to evaluate the full magnitude and population distribution of this effect.

The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure have been extensively investigated over the last two decades. Due to the prevalence of both NSAID use and hypertension, even modest elevations in blood pressure or inhibition of antihypertensive medication efficacy resulting from NSAIDs may be of significant clinical and public health importance. Despite the relative abundance of clinical trials that have sought to resolve the importance of this issue, firm conclusions still have not been reached. This review analyzes current data regarding the effect of NSAID use on blood pressure in both normotensive and hypertensive patients.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....