Effect of Non-Steroidal Anti-Inflammatory Drugs on Control of Hypertension by Beta-Blockers and Diuretics

Wong, Dickson; Lamki, Lamk; Spence, J. David; Freeman, Dave; McDonald, John W.D.

doi:10.1016/s0140-6736(86)91271-7

Cited by 121 publications

(48 citation statements)

References 28 publications

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“…Diuretics, for instance, are one example of a commonly prescribed medication which might have its action compromised by NSAIDs use. 217,218 Brooke was atypical in stating that all participants in the trial had existing illnesses, such as cardiovascular conditions and diabetes, although typical in not reporting any medication usage by patients, other than the use of study drugs.…”

Section: Description Of Co-medicationmentioning

confidence: 99%

The causes and effects of socio-demographic exclusions from clinical trials

Bartlett¹,

Doyal²,

Ebrahim³

et al. 2005

Health Technol Assess

180

136

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Section: Description Of Co-medicationmentioning

confidence: 99%

The causes and effects of socio-demographic exclusions from clinical trials

Bartlett¹,

Doyal²,

Ebrahim³

et al. 2005

Health Technol Assess

180

136

View full text Add to dashboard Cite

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“…Most classes of antihypertensive drugs appear to be affected; these include diuretics, 2 ␤-blockers, 2,3 and angiotensin-converting enzyme inhibitors (ACEIs). 4 -7 The most widely studied of the NSAID medications is indomethacin, which has been shown to increase mean blood pressure by as much as 5 mm Hg in treated hypertensive patients.…”

mentioning

confidence: 99%

Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients

et al. 2000

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Abstract-NSAIDs are known to attenuate the effects of some antihypertensive medications. It is not known whether the new class of angiotensin II receptor antagonists is similarly affected. We conducted a multicenter study assessing the effect of indomethacin on the antihypertensive effects of losartan and captopril. After 4 weeks of placebo washout, hypertensive patients received 6 weeks of active antihypertensive therapy with either 50 mg losartan once daily (nϭ111) or 25 mg captopril twice daily for 1 week, which was increased to 50 mg twice daily for 5 weeks (nϭ105). This was followed by 1 week of concomitant therapy with indomethacin (75 mg daily). The primary outcome measure was the change in mean 24-hour ambulatory diastolic blood pressure after the addition of indomethacin. Key Words: hypertension, essential Ⅲ indomethacin Ⅲ losartan Ⅲ captopril Ⅲ blood pressure N onsteroidal anti-inflammatory drugs (NSAIDs) are among the most common classes of medications prescribed in the United States. The availability of over-thecounter formulations has increased their use further, particularly among the elderly. 1 Given the high prevalence of hypertension, it is likely that concomitant use of NSAIDs and antihypertensive medication will occur in the same patient.There are numerous studies and meta-analyses that have focused on the adverse effects of NSAID medications on blood pressure and the blunting of the efficacy of antihypertensive medications. Most classes of antihypertensive drugs appear to be affected; these include diuretics, 2 ␤-blockers, 2,3 and angiotensin-converting enzyme inhibitors (ACEIs). 4 -7 The most widely studied of the NSAID medications is indomethacin, which has been shown to increase mean blood pressure by as much as 5 mm Hg in treated hypertensive patients. 8 The clinical relevance of these blood pressure changes can be tied to the observation that NSAID use in the elderly is associated with an increased likelihood of the subsequent initiation of antihypertensive therapy. 9 In part, the increase in blood pressure resulting from NSAID administration may be nonspecific (ie, related to fluid retention), and these effects may affect antihypertensive medications equally. However, given the inhibition of prostaglandin synthesis by NSAIDs, there is reason to believe that ACEIs may be particularly affected. ACEIs prevent the breakdown of bradykinin, which has been shown to increase prostaglandin synthesis. 10 Not unexpectedly, concomitant administration of indomethacin in captopril-treated patients reversed 40% of the antihypertensive effect in hypertensive patients 4,5 and attenuated the favorable hemodynamic effects in patients with congestive heart failure. 7 The new class of antihypertensive agents, angiotensin II receptor antagonists, directly opposes the interaction of angiotensin II with its cell surface receptor. Angiotensin II receptor antagonists reduce blood pressure to a degree similar to that for most other classes of antihypertensive medications. However, in contrast to ACEI, there is ...

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“…The only permitted nonsteroidal anti-inflammatory drug (NSAID) was sulindac, which unlike other NSAIDs, does not impair hypertension control. [14] As is routine in our clinics, participants were given at baseline repeat instructions, educational materials, and recipes to aid them in restricting intake of sodium by eliminating added salt, avoiding salty foods, and following a Mediterranean diet.…”

Section: Concomitant Medicationsmentioning

confidence: 99%

Effects of eplerenone on resistance to antihypertensive medication in patients with primary or secondary hyperaldosteronism

Spence

Bogiatzi

Kuk

et al. 2017

Journal of Translational Internal Medicine

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Background and Objectives: Resistant hypertension is an important problem; nearly half of diagnosed hypertensives are not controlled to target blood pressure levels, and approximately 90% of strokes occur among patients with resistant hypertension. Primary aldosteronism accounts for approximately 20% of resistant hypertension, but the role of secondary hyperaldosteronism in resistant hypertension is seldom considered. We assessed the effects of eplerenone in patients with hypertension and either primary or secondary hyperaldosteronism. Methods: Patients with a history of resistant hypertension and a supine plasma aldosterone level ≥ 360 pmol/L were randomized to eplerenone versus placebo in a fully blinded study for one year. A medication intensity score was developed to assess the resistance of hypertension to medication (blood pressure × medication intensity). We assessed the effects of eplerenone on blood pressure and on resistance to concomitant medication. Results: Final results were available in 37 patients (19 on eplerenone and 18 on placebo). Resistance to medication, as assessed by the intensity of concomitant medication required to maintain blood pressure control, was markedly reduced by eplerenone: medication intensity scores declined by −0.50 ± 1.04 (SD) on placebo versus −2.11 ± 1.45 with eplerenone (P = 0.0001), the Systolic Resistance Score declined by −80.00 ± 122.93 on placebo versus −334.05 ± 21.73 on eplerenone (P = 0.0001), and the Diastolic Resistance Score increased by 1.28 ± 31.65 on placebo and declined by −40.74 ± 57.08 on eplerenone (P = 0.009). Conclusions: Eplerenone significantly reduced resistance to concomitant antihypertensive medication in both primary and secondary hyperaldosteronism.

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Effect of Non-Steroidal Anti-Inflammatory Drugs on Control of Hypertension by Beta-Blockers and Diuretics

Cited by 121 publications

References 28 publications

The causes and effects of socio-demographic exclusions from clinical trials

The causes and effects of socio-demographic exclusions from clinical trials

Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients

Effects of eplerenone on resistance to antihypertensive medication in patients with primary or secondary hyperaldosteronism

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