Abstract
BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension.MethodsWe conducted a retrospective cohort study of adult hypertensive patients to determine the effects of their first prescription for NSAID on systolic blood pressure and antihypertensive drug intensification. Data were collected from an electronic medical record serving an academic general medicine practice in Indianapolis, Indiana, USA. Using propensity scores to minimize bias, we matched a cohort of 1,340 users of NSAIDs with 1,340 users of acetaminophen. Propensity score models included covariates likely to affect blood pressure or the use of NSAIDs. The study outcomes were the mean systolic blood pressure measurement after starting NSAIDs and changes in antihypertensive therapy.ResultsCompared to patients using acetaminophen, NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10). The systolic blood pressure increase was 3 mmHg in a subgroup of patients concomitantly prescribed angiotensin converting enzyme inhibitors or calcium channel blockers and 6 mmHg among those prescribed a beta-adrenergic blocker. Blood pressure changes in patients prescribed diuretics or multiple antihypertensives were not statistically significant.ConclusionCompared to acetaminophen, incident use of NSAIDs, particularly ibuprofen, is associated with a small increase in systolic blood pressure in hypertensive patients. Effects in patients prescribed diuretics or multiple antihypertensives are negligible.
Highlights
Nonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care
We aimed to determine the comparative effects on systolic blood pressure of NSAIDs that are commonly used in primary care
Patients were eligible for inclusion if they had received a prescription for any NSAID between 1993 and 2006, were aged 18 years or older, and had a clinical diagnosis of hypertension on the index date
Summary
Nonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of hypertension has been previously investigated [4,5,6,7,8]; little information is available about the magnitude of changes in blood pressure in populations of patients chronically taking antihypertensive medications. We examined the association between NSAIDs and blood pressure in patients with hypertension who were taking antihypertensive medications This observational study included incident users of NSAIDs and used propensity scores to minimize selection bias. Using these methods, we aimed to determine the comparative effects on systolic blood pressure of NSAIDs that are commonly used in primary care. Our objectives were to: (1) examine the association between NSAIDs and blood pressure compared to acetaminophen in patients with hypertension; (2) compare the effects of various NSAIDs on blood pressure in patients with hypertension; and, (3) examine changes in antihypertensive therapy after starting NSAIDs
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