Non‐steroidal anti‐inflammatory drugs and hypertension in the elderly: a community‐based cross‐sectional study.

Ag, Johnson; La, Simons; Simons, Judith; Friedlander, Yechiel; McCallum, John

doi:10.1111/j.1365-2125.1993.tb04169.x

Cited by 84 publications

(33 citation statements)

References 30 publications

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“…In a cohort of 133 community-dwelling elderly subjects taking antihypertensive medications, 24 the odds of having a systolic blood pressure Ͼ140 mm Hg were higher in NSAID users (OR, 2.19; 95% CI, 1.33 to 3.61) than in control subjects matched for age, gender, and BMI. In the second study, 25 NSAID use was significantly associated with hypertension only in subjects taking antihypertensive medications (OR, 1.4; 95% CI, 1.1 to 1.7). Users of aspirin and NSAIDs were pooled, and neither intensity of antihypertensive medication use nor concomitant use of acetaminophen was controlled for in this analysis.…”

Section: Discussionmentioning

confidence: 89%

Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

et al. 2002

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Abstract-Acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) are widely consumed. Each is theoretically capable of elevating blood pressure by altering prostaglandin homeostasis; however, there is little prospective information on the relation between these agents and physician-diagnosed hypertension. We examined the association between the use of aspirin, acetaminophen, or NSAIDs and incident hypertension in a prospective cohort study of 51 630 women 44 to 69 years of age in 1990 who had no history of hypertension or chronic renal insufficiency. Analgesic use was assessed in 1990 by a mailed questionnaire, and the women were followed for 8 years. Key Words: hypertension, essential Ⅲ drug therapy Ⅲ blood pressure Ⅲ risk factors A spirin, acetaminophen, and ibuprofen are the three most commonly used medications among adults 18 years of age and older, according to a national survey of US households conducted between 1998 and 1999. 1 Seventeen percent of respondents reported using aspirin in the preceding week, 23% reported acetaminophen use, and 17% ibuprofen use. Prevalence of use was greater among women than men for acetaminophen and ibuprofen.Short-term prospective studies suggest nonsteroidal antiinflammatory drugs (NSAIDs) can cause acute elevations in blood pressure, 2,3 but a diagnosis of hypertension was used as the primary outcome in only one case-control study. 4 Although aspirin and acetaminophen also influence prostaglandin homeostasis, 5-7 prospective data on their potential hypertensive effects have been sparse and inconclusive. 8,9 A recent study of these effects in a large cohort of younger US women demonstrated an increased incidence of hypertension in users of NSAIDs and acetaminophen but not aspirin (OR 1.86 and 2.00, respectively, for the highest use category, PϽ0.001). 10 Twenty-four percent of US adults and 50% to 70% of those Ͼ60 years of age have hypertension. 11 Even small elevations in blood pressure caused by nonnarcotic analgesic use could affect cardiovascular morbidity and mortality. 12 To examine this issue, we studied the association between the use of aspirin, acetaminophen, and NSAIDs and incident hypertension in a large cohort of US women. Methods The Nurses' Health StudyThe Nurses' Health Study cohort was assembled in 1976 when 121 700 female registered nurses, 30 to 55 years of age, completed and returned a mailed questionnaire. 13 Follow-up questionnaires have been mailed every 2 years to update information on healthrelated behaviors and medical events. In 1990, questions were included regarding frequency of use of acetaminophen, aspirin, and other NSAIDs. Study PopulationThe 1990 questionnaire was answered by 85 625 women. Women who reported a history of hypertension (nϭ27 344) or chronic kidney failure (nϭ10) on or before the 1990 questionnaire were excluded from the study, as were women who did not answer any of the questions on analgesic use (nϭ336). We also excluded subjects who did not report having had a physical examination between 1988

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Section: Discussionmentioning

confidence: 89%

Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

et al. 2002

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“…Based on this discovery, one might expect that conventional nonselective nonsteroidal antiinflammatory drugs (NSAIDs) other than coxibs should be neutral or even beneficial to the cardiovascular system. However, a significantly increased risk for cardiovascular diseases such as myocardial infarction (MI), hypertension, and heart failure has also been observed to be associated with the administration of the nonaspirin conventional NSAIDs, including but not limited to diclofenac, ibuprofen, naproxen, and indomethacin (8)(9)(10)(11)(12). In addition, there could be rofecoxib-specific events such as the facile formation of a cardiotoxic maleic anhydride derivative from rofecoxib that may contribute to its adverse effects (13).…”

mentioning

confidence: 99%

Metabolic profiling of murine plasma reveals an unexpected biomarker in rofecoxib-mediated cardiovascular events

Liu

Yang

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

122

102

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Chronic administration of high levels of selective COX-2 inhibitors (coxibs), particularly rofecoxib, valdecoxib, and parecoxib, increases risk for cardiovascular disease. Understanding the possibly multiple mechanisms underlying these adverse cardiovascular events is critical for evaluating the risks and benefits of coxibs and for development of safer coxibs. The current understanding of these mechanisms is likely incomplete. Using a metabolomics approach, we demonstrate that oral administration of rofecoxib for 3 mo results in a greater than 120-fold higher blood level of 20-hydroxyeicosatetraenoic acid (20-HETE), which correlates with a significantly shorter tail bleeding time in a murine model. We tested the hypothesis that this dramatic increase in 20-HETE is attributable to inhibition of its metabolism and that the shortened bleeding time following rofecoxib administration is attributable, in part, to this increase. The s.c. infusion of 20-HETE shortened the tail bleeding time dramatically. Neither 20-HETE biosynthesis nor cytochrome P4A-like immune reactivity was increased by rofecoxib administration, but 20-HETE production increased in vitro with the addition of coxib. 20-HETE is significantly more potent than its COX-mediated metabolites in shortening clotting time in vitro. Furthermore, 20-HETE but not rofecoxib significantly increases rat platelet aggregation in vitro in a dose-dependent manner. These data suggest 20-HETE as a marker of rofecoxib exposure and that inhibition of 20-HETE's degradation by rofecoxib is a partial explanation for its dramatic increase, the shortened bleeding time, and, possibly, the adverse cardiovascular events associated with rofecoxib. cardiovascular side effect | coxib | eicosanoids | metabolomics | Vioxx

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“…There was also insufficient control of important confounding factors (pretreatment BP, salt intake, comorbidity, smoking and alcohol). A second cross-sectional study 7 suggested that NSAID usage might be an independent risk factor for the presence of hypertension. They looked at 2800 elderly noninstitutionalised patients and found 26% were prescribed NSAIDs and 12% taking them concurrently with antihypertensive medication.…”

Section: Context Of Other Studiesmentioning

confidence: 99%

“…We also found two additional cross-sectional reports and one subgroup analysis of a randomised-controlled trial (RCT). 7,10,20 The first crosssectional study 10 found a 5 mmHg higher SBP (though 95% CI were -0.02 to 9.74) but no effect on DBP in those taking NSAIDs. They studied 235 noninstitutionalised people aged over 65 years currently on NSAIDs with matched controls.…”

Section: Context Of Other Studiesmentioning

confidence: 99%

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

2005

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The objective of this study was to investigate the association between NSAID use and blood pressure (BP) among a sample of treated hypertensive patients. A controlled observational study was designed in UK primary care setting. Patients with diagnosed hypertension and currently being prescribed antihypertensive medication registered with four general practices, comparing patients also prescribed NSAIDs (exposed) to those not prescribed NSAIDs (unexposed). Majority of the patients were elderly. Systolic and diastolic pressure were the outcome measures. Data were collected for 184 NSAID users and 762 nonusers with a mean age of 68 years. There was no difference in either systolic (adjusted difference 1.9 mmHg, 95% CI À0.7 to 4.5, P ¼ 0.15) or diastolic (adjusted difference 1.0 mmHg, 95% CI À0.3 to 2.3, P ¼ 0.15) blood pressure. There was no evidence of any interactions according to categories of age, sex, or number of antihypertensive drugs prescribed. Among NSAID users, there was no evidence of any differences in blood pressure according to NSAID type or dose. In conclusion we found no evidence for an association between NSAID usage and BP control in known hypertensive patients receiving antihypertensive medication in primary care. The reported association between NSAID use and BP control appears much less substantial than has been previously suggested.

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Non‐steroidal anti‐inflammatory drugs and hypertension in the elderly: a community‐based cross‐sectional study.

Cited by 84 publications

References 30 publications

Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

Metabolic profiling of murine plasma reveals an unexpected biomarker in rofecoxib-mediated cardiovascular events

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

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