The effect of tiaprofenic acid on blood pressure control in treated hypertensive patients

Smith, Malcolm D.; Kupa, Ann; Weatherall, M.; Henstridge, John; Brooks, Peter

doi:10.1185/03007998509109609

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Chalmers et al 1984;Mills et al 1982;Salvetti et al 1982a,b;Steiness & Waldorff 1982;Watkins et al 1980 -fig. 7;Wing et al 1981), but has also been reported with piroxicam (Pugliese et al 1984;Wong et al 1986), naproxen (Abate et al 1990;Chalmers et al 1984), ibuprofen (Radack et al 1987), flurbiprofen (Webster et al 1984) and tiaprofenic acid (Smith et al 1985), although not with sulindac or diclofenac (Stokes et al 1991). A wide variety of antihypertensive agents have been involved including diuretics, ~-blockers, angiotensin converting enzyme (ACE) inhibitors and vasodilators.…”

Section: Nsaids Affecting Other Drugsmentioning

confidence: 91%

Adverse Drug Interactions with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

1993

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The prevalence and incidence of adverse drug interactions involving nonsteroidal anti-inflammatory drugs (NSAIDs) remains unknown. To identify those proposed drug interactions of greatest clinical significance, it is appropriate to focus on interactions between commonly used and/or commonly coprescribed drugs, interactions for which there are numerous well documented case reports in reputable journals, interactions validated by well designed in vivo human studies and those affecting high-risk drugs and/or high-risk patients. While most interactions between NSAIDs and other drugs are pharmacokinetic, NSAID-related pharmacodynamic interactions may be considerably more important in the clinical context, and prescriber ignorance is likely to be a major determinant of many adverse drug interactions. Prescribing NSAIDs is relatively contraindicated for patients on oral anticoagulants due to the risk of haemorrhage, and for patients taking high-dose methotrexate due to the dangers of bone marrow toxicity, renal failure and hepatic dysfunction. Combination NSAID therapy cannot be justified as toxicity may be increased without any improvement in efficacy. Where lithium or anti-hypertensives are coprescribed with NSAIDs, close monitoring is mandatory for lithium toxicity and hypertension, respectively, and aspirin (acetylsalicylic acid) or sulindac are preferred. Phenytoin or oral hypoglycaemic agents may be administered with NSAIDs other than pyrazoles and salicylates provided that patients are monitored carefully at the initiation and cessation of NSAID treatment. Digoxin, aminoglycosides and probenecid may be coprescribed with NSAIDs, but close monitoring is required, particularly for high-risk patients such as the elderly. Indomethacin and triamterene should be avoided due to the risk of renal failure. High dose aspirin should be replaced by naproxen in patients on valproic acid (sodium valproate) and care is required when corticosteroids are administered to patients taking salicylates long term in high dosage. Interactions between NSAIDs and antacids or cholestyramine are generally avoidable. Adverse drug interactions involving NSAIDs may be limited by rational prescribing and by careful monitoring, particularly for high-risk patients, drugs and therapy periods.

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Section: Nsaids Affecting Other Drugsmentioning

confidence: 91%

Adverse Drug Interactions with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

1993

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

Morrison

Ramey

Adelsberg

et al. 2007

Current Medical Research and Opinion

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NSAIDs and Increased Blood Pressure

Johnson

1997

Drug Safety

103

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Several randomised studies have demonstrated that various nonsteroidal anti-inflammatory drugs (NSAIDs) elevate blood pressure in normotensive and hypertensive individuals; however, these data have been contradicted by numerous negative studies. Two meta-analyses have demonstrated that, after pooling data drawn from published reports of randomised trials of younger adults, NSAID use produces a clinically significant increment in mean blood pressure of 5 mm Hg, most marked in patients with controlled hypertension. Stratification by NSAID type revealed that piroxicam, naproxen and indomethacin had the greatest, and sulindac the smallest, pressor effect. These data were supported by 2 large community studies involving elderly patients. Recent NSAID users had a 1.7-fold higher risk of requiring the initiation of antihypertensive therapy compared with nonusers; NSAID users also had a 40% increased risk of receiving a diagnosis of hypertension compared with nonusers. It is vital to determine the nature of the association in the elderly, 12 to 15% of whom are concurrently receiving an NSAID and an antihypertensive agent. Importantly, a 5 to 6 mm Hg increase in diastolic blood pressure maintained over a few years may be associated with a 67% increase in total stroke risk and a 15% increase in coronary heart disease events. While the mechanism(s) remain speculative, salt and water retention through several factors operating in parallel, coupled with increased total peripheral vascular resistance, via increased renal endothelin-1 synthesis, are potentially important. Clinicians should strive to avoid excessive use of NSAID treatment and consider well-tolerated therapeutic alternatives, including simple analgesics and physical therapy. For patients who require concomitant NSAID and antihypertensive treatment, physicians should be aware that indomethacin, naproxen and piroxicam may be associated with a greater pressor effect than many other NSAIDs, and that antagonism of beta-blockers may be greater than that of vasodilators (including ACE inhibitors and calcium antagonists) and diuretics. Finally, the progress of each patient should be monitored by careful blood pressure measurement, particularly during the period of initiation of NSAID therapy.

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The effect of tiaprofenic acid on blood pressure control in treated hypertensive patients

Cited by 4 publications

References 15 publications

Adverse Drug Interactions with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Adverse Drug Interactions with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

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

NSAIDs and Increased Blood Pressure

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