Effect of Indomethacin on Blood Pressure Control during Treatment with Nitrendipine

Abstract

This study tested the hypothesis that treatment with a nonsteroidal anti-inflammatory drug will not alter the hypotensive effect of a dihydropyridine calcium channel antagonist. Fifteen essential hypertensives (ages 58-80 years) had a supine diastolic blood pressure (DBP) < 100 mmHg after 4 weeks monotherapy with nitrendipine 5-20 mg twice daily. They entered a double-blind randomised crossover study in which the addition of indomethacin 25 mg three times daily was compared with placebo in treatment phases each of 4 weeks duration. Subjects were seen weekly and measurements in the last 2 weeks of each phase were compared. Supine blood pressure (mean +/- SE) was higher in the indomethacin phase (158 +/- 4/80 +/- 2) than in the placebo phase (154 +/- 4/76 +/- 3) (p < 0.01 for DBP). In 6/15 (40%) of subjects the increase in supine diastolic blood pressure with indomethacin was > 5 mmHg. Plasma urea was also increased in the indomethacin phase: 7.6 +/- 0.6 mmol/l compared with placebo: 6.3 +/- 0.5 mmol/l (p < 0.001). The study has demonstrated that concurrent treatment with the NSAID indomethacin impairs the blood pressure lowering effect of the dihydropyridine calcium channel antagonist nitrendipine. This increase in blood pressure with indomethacin in subjects treated with nitrendipine may represent either an independent pressor effect of indomethacin or a reduced vasodilator prostanoid contribution to the hypotensive effect of nitrendipine. This blood pressure increase may be sufficient to interfere significantly with clinical blood pressure control in some subjects.

The Effect of Nonsteroidal Anti‐Inflammatory Drugs on Blood Pressure in Patients Treated With Different Antihypertensive Drugs

“…This conclusion is based on relatively weak evidence, and sulindac does not reduce blood pressure, as has been claimed 7,10 . When the different drugs have been compared with each other and with placebo, the doses have frequently been in the lower range of the recommended dose 11,12 and the patients studied have been relatively young, with few studies in people older than 60 years. Also, it is uncertain, when drugs are compared, if the same magnitude of pain relief was achieved.…”

“…An important question is whether there are differences between the various NSAIDs. It has been claimed that some nonsteroidal drugs may have a lesser effect on blood pressure than other agents, and that some (sulindac) may even lower blood pressure 7,10–14 . This conclusion is based on relatively weak evidence, and sulindac does not reduce blood pressure, as has been claimed 7,10 .…”