Do Nonsteroidal Anti-inflammatory Drugs Affect Blood Pressure? A Meta-Analysis

Abstract

Nonsteroidal anti-inflammatory drugs may elevate blood pressure and antagonize the blood pressure-lowering effect of antihypertensive medication to an extent that may potentially increase hypertension-related morbidity. Although certain NSAIDs and antihypertensive agents could be more likely to produce these effects, the underlying mechanisms require further study.

NSAID use and BP in treated hypertensives: a retrospective controlled observational study

“…As hypertension and coprescribing of NSAIDs are common in the elderly, any adverse effects from coprescribing may potentially affect a substantial proportion of the elderly community. This reported 9 interaction of NSAIDs on BP could have an important clinical influence 13 in poorly controlled hypertensive patients taking BP-lowering drugs. Indeed, NSAIDs are listed 3,14 as the most important 'antagonising agents' that clinicians need to consider when dealing with treated hypertensive patients who have poorly controlled BP readings.…”

“…In relation to drug-drug interactions, NSAIDs may antagonise angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-II receptor antagonists, diuretics and beta-blockers. 8,9,12,14 There is some evidence 19 that NSAIDs do not antagonise calcium channel blockers. In sum, the weight of biological evidence appears to suggest an adverse effect of NSAIDs on BP control.…”

“…Previous systematic reviews and meta-analyses 4,9 investigating the effects of NSAIDs on BP control have produced conflicting results. Furthermore, there are many methodological shortcomings to the small individual studies included in these systematic reviews.…”

“…Prostaglandins are naturally occurring vasodilators and interact with the reninangiotensin system. 4,[8][9][10][11] Previous studies 4,9,10,12 on NSAIDs and hypertension have produced conflicting results and examined relationships between NSAID usage in nontreated and treated patients. Some NSAIDs (particularly indometacin and naproxen 4 may elevate BP and attenuate the effects of antihypertensives, on average being associated with 5 mmHg rise in mean BP.…”

“…Some NSAIDs (particularly indometacin and naproxen 4 may elevate BP and attenuate the effects of antihypertensives, on average being associated with 5 mmHg rise in mean BP. 9 Some evidence 4 suggests that this may not be a class effect and that not all NSAIDs (eg ibuprofen) will raise BP in this way. As hypertension and coprescribing of NSAIDs are common in the elderly, any adverse effects from coprescribing may potentially affect a substantial proportion of the elderly community.…”