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

Abstract

ABSTRACTObjective: To investigate the effects of continued use of non-selective NSAIDs (nsNSAIDs) on blood pressure and hypertension.Research design and methods: This was a systematic review of randomized clinical trials of oral nsNSAIDs used for at least a 4-week duration. Searches were conducted of PubMed and the Cochrane Database of Systematic Reviews, using key terms for nsNSAIDs and blood pressure or hypertension, to identify articles published in the English language peer-reviewed literature through March 2007.Main outcome measures: Change from baseline to end of study in systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the incidence of hypertension. Pooled statistics were computed using fixed and random-effects analyses.Results: Thirty-two articles were included. The mean change (95% confidence interval [CI]) in blood pressure (in mmHg) from baseline to end of study for five trials of ibuprofen was 3.54 (2.70, 4.39) for SBP and 1.16 (0.68, 1.64) for DBP ( p < 0.001 for both changes). Results of four trials of indomethacin were similar to those for ibuprofen: 2.90 (–0.28, 6.08) for SBP ( p = 0.07) and 1.58 (0.29, 2.87) for DBP ( p = 0.02). Mean changes from baseline for two trials of diclofenac were –0.46 (–1.48, 0.56) for SBP ( p = 0.38) and –0.56 (–1.19, 0.07) for DBP ( p = 0.08) and were similar to those for placebo. Changes from baseline in SBP were positive but not statistically significant for naproxen, sulindac, and nabumetone. Compared with placebo, the risk ratio (95% CI) for hypertension was 2.85 (1.44, 5.65; p = 0.003) in two ibuprofen trials.Conclusions: 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.