INTERACTION BETWEEN ANTIHYPERTENSIVES AND NSAIDS IN PRIMARY CARE: A CONTROLLED TRIAL
Main Article Content
Keywords
Antihypertensive drugs, family practice, interaction, non-steroidal anti -inflammatory drugs
Abstract
Background
Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives. It seems that NSAIDs and the antihypertensive drugs differ in their propensity to such an interaction.
Objectives
To determine the extent of the interaction between two antihypertensives and three NSAIDs.
Methods
A prospective clinical trial in a family practice included 88 treated hypertensives aged over 55 years; 39 controls and 49, also taking NSAIDs for osteoarthritis. During this 3-month study, two antihypertensives, lisinopril/hydrochlorothiazide and amlodipine, were compared with three NSAID s: ibuprofen, acetaminophen, and piroxicam. BP was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting, and supine position.
Results
The average starting blood pressure in the study group was 149.3±9.8/88.6±6.8 mm Hg. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated systolic BP by 7.7-9.9% (p<0.001), which, during the acetaminophen period, decreased by 6.9-9.4% to 0.3-0.9% above baseline (p<0.001), increasing again by 7.0-7.7% (p<0.001) during the second exposition to these drugs. In the amlodipine subgroup, ibuprofen or piroxicam increased BP by 1.1-1.6% (p>0.290) only, and there were no significant shifts in the follow-up periods. Analogous deviations were observed with bo th measurement devices, in all the examinee’s positions. In the control group, BP did not change appreciably.
Conclusions
Piroxicam and ibuprofen markedly blunt the effects of antihypertensive drugs while acetaminophen is almost inert. Lisinopril/hydrochlorothiazide combination is much more affected by this interaction than amlodipine (ClinicalTrials.gov #NCT00631514).
References
2. Antman EM, DeMets D, Loscalzo J. Cyclooxygenase inhibition and cardiovascular risk. Circulation 2005;112:759-70.
3. Chalmers JP, West MJ, Wing LM, Bune AJ, Graham JR. Effects of indomethacin, sulindac, naproxen, aspirin, and acetaminophen in treated e380 Interaction between antihypertensives and NSAIDs in primary care: a controlled trial hypertensive patients. Clin Exp Hypertens 1984;A6:1077-93.
4. Radack KL, Deck CC, Bloomfield SS. Ibuprofen interferes with the efficacy of antihypertensive drugs. A randomized, doubleblind, placebo-controlled trial of ibuprofen compared with acetaminophen. Ann Intern Med 1987;107:628-35.
5. Morgan T, Anderson A. Interaction of indomethacin with felodipine and enalapril. J Hypertens 1993; 11 (suppl 5):S334-8.
6. Perneger TV, Whelton PK, Klag MJ. Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs. N Engl J Med 1994;331:1675-9.
7. Gurwitz JH, Avorn J, Bohn RL, Glynn RJ, Monane M, Mogun H. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA 1994;272:781-6.
8. Klassen DH, Jane LH, Young DY, Peterson CA. Assessment of blood pressure during naproxen therapy in hypertensive patients treated with nicardipine. Am J Hypertens 1995; 8:146-53.
9. Houston MC, Weir J, Gray J, et al. The effects of nonsteroidal anti-inflammatory drugs on blood pressure of patients with hypertension controlled by verapamil. Arch Intern Med 1995;155:1049-54.
10. Polonia J, Bonaventura I, Gama G, et al. Influence of non-steroidal anti-inflammatory drugs on renal function and 24h ambulatory blood pressure-reducing effects of enalapril and nifedipine gastrointestinal therapeutic system in hypertensive patients. J Hypertens 1995; 13:92531.
11. Gurwitz JH, Everitt DE, Monane M, et al. The impact of ibuprofen on the efficacy of antihypertensive treatment with hydrochlorothiazide in elderly persons. J Gerontol A Biol Sci Med Sci 1996;51 M74-9.
12. Guazzi MD, Campodonico J, Celeste F, et al. Antihypertensive efficacy of angiotensin converting enzyme inhibition and aspirin counteraction. Clin Pharmacol Ther 1998;63:7986.
13. Thakur V, Cook ME, Wallin JD. Antihypertensive effect of the combination of fosinopril and HCTZ is resistant to interference by nonsteroidal anti-inflammatory drugs. Am J Hypertens 1999;12:925-8.
14. Conlin PR, Moore TJ, Swartz SL, et al. Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension 2000;36:461-5.
15. Morgan TO, Anderson A, Bertram D. Effect of indomethacin on blood pressure in elderly people with essential hypertension well controlled on amlodipine or enalapril. Am J Hypertens 2000;13:1161-7.
16. Savenkov MP, Ivanov SN, Broskaya SA. Antihypertensive effect of enalapril and lisinopril administered in combination with nonsteroidal anti-inflammatory agents [in Russian]. Ter Arkh 2001;73:27-31.
17. Morgan T, Anderson A, MacInnis RJ. ACE inhibitors, beta-blocking drugs, calcium channel blocking drugs and diuretics for the control of elevated blood pressure in the elderly: a double blind crossover study in previously untreated patients. Am J Hypertens 2001;14: 241-7.
18. Fogari R, Zoppi A, Carretta R. Effect of indomethacin on the antihypertensive efficacy of valsartan and lisinopril: a multicentre study. J Hypertens 2002;20:1007-14.
19. Dabrowski R, Kowalik I, Maciag A, Sosnowski C, Szwed H. Aspirin 300 mg significantly attenuates hypotensive effects of ACE-inhibitor in single-blind, cross-over, randomized comparison to aspirin 100 mg dose in hypertensive patients with metabolic syndrome. ESC Congress Munich 2004. Eur Heart J 2004; 25 (Abstract Suppl):663; #3806.
20. Pope JE, Anderson JJ, Felson DT. A metaanalysis of the effects of nonsteroidal anti- inflammatory drugs on blood pressure. Arch Intern Med 1993;153:477-84.
21. Johnson AG, Nguyen TV, Day RO. Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis. Ann Intern Med 1994; 121:289-300.
22. Aw TJ, Haas SJ, Liew D, Krum H. Meta- analysis of cyclooxygenase-2 inhibitors and their effects ob blood pressure. Arch Intern Med 2005;165:490-6.
23. Armstrong EP, Malone DC. The impact of nosteroidal anti-inflammatory drugs on blood pressure, with an emphasis on newer agents. Clin Ther 2003;25:1-18.
24. Morgan T, Anderson A. The effect of nonsteroidal anti -inflammatory drugs on blood pressure in patients treated with different antihypertensive drugs. J Clin Hypertens (Greenwich) 2003;5:53-7.
25. White WB. Hypertension associated with therapies to treat arthritis and pain. Hypertension 2004; 44:123-4.
26. Borer JS, Simon LS. Cardiovascular and gastrointestinal effects of COX-2 inhibitors and NSAIDs: achieving a balance. Arthritis Res Ther 2005;7 (suppl 4):S14-S22. Interaction between antihypertensives and NSAIDs in primary care: a controlled trial
27. Whelton A. Clinical implications of nonopioid analgesia for relief of mild-to-moderate pain in patients with or at risk for cardiovascular disease. Am J Cardiol 2006;97:3-9.
28. Wilson SL, Poulter NR. The effect of nonsteroidal anti-inflammatory drugs and other commonly used non-narcotic analgesics on blood pressure levels in adults. J Hypertens 2006;24:1457-69.
29. Johnson J, Weinryb J. Safe pharmacologic treatment strategies for osteoarthritis pain in African Americans with hypertension, and renal and cardiac disease. J Natl Med Assoc 2006;98:1126-35.
30. Dragun A, Russo A, Rumboldt M. Socioeconomic stress and drug consumption: unemployment as an adverse health factor in Croatia. Croat Med J 2006;47:685-92.
31. Aronoff DM, Oates JA, Boutaud O. New insights into the mechanism of action of acetaminophen: its clinical pharmacologic characteristics reflect its inhibition of the two prostaglandin H synthases. Clin Pharmacol Ther 2006;79:9-19.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.