Systematic review of trials of the effect of continued use of oral non-selective NSAIDs on blood pressure and hypertension

Morrison, Alan; Ramey, Dena R.; Adelsberg, Janet van; Watson, Douglas J.

doi:10.1185/030079907x219553

Cited by 50 publications

(31 citation statements)

References 32 publications

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“…In a clinical study, RA patients treated with the non-selective NSAIDs ibuprofen and indomethacin showed an increase in blood pressure within 4 weeks of treatment when compared to the placebo group (Morrison et al, 2007). Consequently, RA patients at a higher risk for gastrointestinal toxicity and genetically predisposed to cardiovascular complications are advised to avoid their long-term use (Panoulas, Metsios, 2008).…”

Section: Egcg For the Treatment Of Vascular Inflammationmentioning

confidence: 99%

Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis

et al. 2013

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Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints in which systemic overproduction of pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) may accelerate cardiovascular (CV) complications. Synovial inflammation in RA spreads systemically and transforms silently into chronic inflammation manifested by increased cytokine release and abnormally high levels of acute reactive proteins (ARPs) such as C-reactive protein (CRP), suggesting inflammation as a connecting link between RA and CV dysfunction. While the treatment to improve CV function in RA patients is being validated, it is timely to propose and test two-pronged therapies that ameliorate arthritis concomitant to improving CV functions. In this review, we summarized the pre-clinical and clinical studies validating the cardiovascular and anti-rheumatic activities of epigallocatechin-3 gallate (EGCG), a potent anti-inflammatory molecule found in green tea. The review also draws many parallels that have emerged between the paradigm of cytokine-driven inflammation in the pathogenesis of RA and its CV complications. Finally, based on extensive clinical evidence of the ‘synovial inflammation-systemic inflammation’ link and the benefits of EGCG in regulating these two pathologies via common driving factors, authors put forward an argument that EGCG may be tested for its potential CV benefit along with anti-rheumatic activity in animal models of human RA.

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Section: Egcg For the Treatment Of Vascular Inflammationmentioning

confidence: 99%

Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis

et al. 2013

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“…As would be expected, nonsteroidal anti-inflammatory drug use was highly prevalent in the allopurinol group. Nonsteroidal anti-inflammatory drug use increases BP, 24 and this would likely bias the results toward the null and attenuate the fall in BP seen. Although we explored the relationship between baseline uric acid level and change in BP, the sample size was small, and we could not assess change in uric acid level.…”

Section: Downloaded Frommentioning

confidence: 99%

Allopurinol Initiation and Change in Blood Pressure in Older Adults With Hypertension

et al. 2014

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H yperuricemia is associated with incident hypertension, 1 and preclinical studies support a role for hyperuricemia in the development of hypertension. Hyperuricemia has been shown to raise blood pressure (BP) in normotensive rats, and this rise is attenuated by urate-lowering drugs.2 Furthermore, sustained hyperuricemia has been shown to induce a primary renal arteriolopathy and a salt-sensitive rise in BP in experimental models. Recently, randomized placebo-controlled and blinded clinical trials have shown that urate-lowering drugs reduce BP in hyperuricemic, hypertensive adolescents and in obese adolescents with prehypertension. 4,5 In 1 study, both allopurinol (a xanthine oxidase inhibitor that reduces the formation of uric acid) and probenecid (a uricosuric drug) were studied.5 For similar reductions in uric acid, both agents were associated with significant reduction in systolic BP, suggesting that the effect is mediated by uric acid reduction per se.Whether serum uric acid has a direct pathophysiological role in the sequelae of hypertension in older adults is less clear. A recent analysis of 6984 patients undergoing treatment for hypertension showed no relationship between baseline serum uric acid level and long-term BP change, although it did show an association between high uric acid level and decline in renal function.6 Equally, it is less clear whether drugs that lower uric acid also lower BP in adults with hypertension. A meta-analysis of the effect of allopurinol on BP, combining data from 10 clinical studies with 738 participants, found a small reduction in BP in allopurinol-treated patients (3.3 mm Hg; 95% confidence interval [CI], −1.4 to −5.3 mm Hg) for systolic BP. 7 We hypothesized that, similar to in adolescents, the initiation of allopurinol would be associated with a fall in BP in older adults with hypertension and that higher doses would have a greater effect. We extracted data from the UK Clinical Practice Research Datalink (CPRD, formally General Practice Research Database) to test this hypothesis. Materials and MethodsThe CPRD is the world's largest computerized database of anonymized longitudinal clinical records from primary care.8 It contains data on demographic characteristics, diagnoses, prescriptions, referrals to secondary care, and medical history.9 Information is collected from >500 practices giving details of >3.4 million patients, and the Abstract-Hypertension is a key risk factor for cardiovascular disease, and new treatments are needed. Uric acid reduction lowers blood pressure (BP) in adolescents, suggesting a direct pathophysiological role in the development of hypertension. Whether the same relationship is present in older adults is unknown. We explored change in BP after allopurinol initiation using data from the UK Clinical Practice Research Datalink. Data were extracted for patients with hypertension aged >65 years who were prescribed allopurinol with pretreatment and during treatment BP readings. Data from comparable controls were extracted. The change in BP in patie...

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“…An RCT [83], a large meta-analysis [84], and a systematic review of RCTs [85] all found small and occasionally significant increases in blood pressure due to prescription dose NSAID use. Given these data, it is not unexpected that some trials observed an increased risk of drug–drug interactions when prescription-strength tNSAIDs and antihypertensives were co-administered over a period of several weeks [86–88].…”

Section: Cardiovascular Safetymentioning

confidence: 99%

Clinical Pharmacology and Cardiovascular Safety of Naproxen

Angiolillo

Weisman

2016

Am J Cardiovasc Drugs

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The voluntary withdrawal of Vioxx (rofecoxib) from the market in 2004, as well as the 2005 and 2014 US FDA Advisory Committee meetings about non-steroidal anti-inflammatory drugs (NSAIDs) and cardiovascular risk, have raised questions surrounding the use of NSAIDs in at-risk populations. This paper discusses the cardiovascular safety profile of naproxen in the context of the NSAID class. The balance of evidence suggests that cardiovascular risk correlates with cyclooxygenase (COX)-2 selectivity, and the low COX-2 selectivity of naproxen results in a lower cardiovascular risk than that of other NSAIDs. The over-the-counter (OTC) use of naproxen is expected to pose minimal cardiovascular risk; however, the benefit–risk ratio and appropriate use should be considered at an individual patient level, particularly to assess underlying conditions that may increase the risk of events. Likewise, regulatory authorities should revisit label information periodically to ensure labeling reflects the current understanding of benefits and risks.

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Systematic review of trials of the effect of continued use of oral non-selective NSAIDs on blood pressure and hypertension

Abstract: Continued use of ibuprofen increases blood pressure and raises the incidence of hypertension. There appears to be heterogeneity in such effects with continued use of other nsNSAIDs but, due to limitations in the data, results for naproxen, sulindac, and nabumetone are inconclusive.

Cited by 50 publications

References 32 publications

Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis

Potential benefits of green tea polyphenol EGCG in the prevention and treatment of vascular inflammation in rheumatoid arthritis

Allopurinol Initiation and Change in Blood Pressure in Older Adults With Hypertension

Clinical Pharmacology and Cardiovascular Safety of Naproxen

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