Effect of High-Dose Ibuprofen on 24-Hour Blood Pressure in Healthy Women

Abstract

The nonsteroidal antiinflammatory drug (NSAID) indomethacin has been shown to increase blood pressure in normotensive individuals. The effect of other NSAID on blood pressure has not been as well studied. We evaluated the effects of ibuprofen, an NSAID currently available without a prescription, on 24-hour ambulatory blood pressure in ten young, healthy, normotensive women. Using a randomized, crossover, double-blind design, subjects received ibuprofen 800 mg and a placebo identical in appearance to ibuprofen three times a day for eight days with a washout period between regimens. Subjects were instructed to follow a no-added salt diet during the study. Twenty-four-hour blood pressure monitoring and 24-hour urine collection for prostaglandin E2, creatinine, and sodium were performed on days 1 and 8 of each study week. Tablet counts and a 40 percent reduction in urinary prostaglandin E2 documented compliance with ibuprofen. Ibuprofen had no significant effect on systolic or diastolic blood pressure at any hour during the 24-hour period. Mean blood pressure for the 24-hour period was 112/73 and 111/73 mm Hg on day 1 and 111/73 and 112/73 mm Hg on day 8 for placebo and ibuprofen, respectively. We conclude that ibuprofen at doses as high as 2400 mg/d for up to seven days has no effect on blood pressure in normotensive women. Further studies are needed in hypertensive subjects.

The effect of non-steroidal anti-inflammatory drugs and other commonly used non-narcotic analgesics on blood pressure level in adults

“…There is consistent evidence from case reports [23,24], observational studies [8,9,[13][14][15][16][17] and clinical trials [10][11][12][18][19][20][21][22] of an association between NSAID use and increased blood pressure in both normotensive and hypertensive adults. What is less consistent is the evidence concerning the magnitude of the blood pressure change.…”

“…The effect of ibuprofen on 24-h ambulatory blood pressure was studied in 10 healthy young women in a doubleblind, placebo-controlled, randomized cross-over design [10]. The subjects' mean age was 33 (AE 6) years and they were on no other medication.…”

“…The shortcomings include the fact that most of the studies were small and short term and hence were underpowered to detect blood pressure differences [11,12]. In addition, different methods have been used to report blood pressure changes, including mean arterial pressure [11,12], systolic and diastolic blood pressure [10,[17][18][19][20][21][22][23][24] and incidence of hypertension [8,9,13,14]. This has been compounded by direct comparisons between NSAID studies reporting change in mean arterial blood pressure with reviews of cardiovascular outcome data based on diastolic blood pressure [12].…”

“…It is certainly biologically plausible that NSAIDs cause raised blood pressure by blocking synthesis of prostaglandins that regulate vascular tone and sodium excretion [4][5][6][7]. While much has been published in the literature concerning the possible association between NSAIDs and risk of hypertension, controversy continues about the magnitude of the blood pressure change and whether the risks are similar for all NSAID users [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. This uncertainty arises from a number of factors related to shortcomings in the design and conduct of the reported studies which have generated inconsistent and unreliable results.…”

The different patterns of blood pressure elevation by rofecoxib and nabumetone

“…Among the drugs studied, indometacin and piroxicam seem to be associated with the largest increase in blood pressure, 15,16 whereas ibuprofen was shown to have no effect on blood pressure in normotensive subjects. 17 There have recently been a few studies that investigated the affect of COX-2 specific NSAID on blood pressure. Some studies have shown an increase in blood pressure for both drugs celecoxib and rofecoxib.…”