Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension

BMC Cardiovascular Disorders

Michael D Murray⁶  D Craig Brater³  Susan J Blalock⁵  Richard A Hansen⁴  Wanzhu Tu¹  Hisham Aljadhey² 

[1] Regenstrief Institute, Inc, Indianapolis, IN, USA;Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia;Indiana University School of Medicine, Indianapolis, IN, USA;Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, AL, USA;Division of Pharmaceutical Outcomes & Policy, School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA;Purdue University College of Pharmacy, West Lafayette, IN, USA

关键词: Propensity score;    Blood pressure;    Hypertension;    NSAIDs;   

Others  :  858043
DOI  :  10.1186/1471-2261-12-93

 received in 2012-06-08, accepted in 2012-10-15,  发布年份 2012

【 摘 要 】

Background

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 objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension.

Methods

We 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.

Results

Compared 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.

Conclusion

Compared 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.

【 授权许可】

   
2012 Aljadhey et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Yach D, Hawkes C, Gould CL, Hofman KJ: The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA 2004, 291(21):2616-2622.
• [2]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al.: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42(6):1206-1252.
• [3]American Heart Association: High Blood Pressure Statistics. 2008. Available at: http://www.americanheart.org/presenter.jhtml?identifier=2139 webcite. Accessed 01/15/2008
• [4]Johnson AG, Simons LA, Simons J, Friedlander Y, McCallum J: Non-steroidal anti-inflammatory drugs and hypertension in the elderly: a community-based cross-sectional study. Br J Clin Pharmacol 1993, 35(5):455-459.
• [5]Dedier J, Stampfer MJ, Hankinson SE, Willett WC, Speizer FE, Curhan GC: Nonnarcotic analgesic use and the risk of hypertension in US women. Hypertension 2002, 40(5):604-608.
• [6]Kurth T, Hennekens CH, Sturmer T, Sesso HD, Glynn RJ, Buring JE, et al.: Analgesic use and risk of subsequent hypertension in apparently healthy men. Arch Intern Med 2005, 165(16):1903-1909.
• [7]Solomon DH, Schneeweiss S, Levin R, Avorn J: Relationship between COX-2 specific inhibitors and hypertension. Hypertension 2004, 44(2):140-145.
• [8]Wang J, Mullins CD, Mamdani M, Rublee DA, Shaya FT: New diagnosis of hypertension among celecoxib and nonselective NSAID users: a population-based cohort study. Ann Pharmacother 2007, 41(6):937-943.
• [9]Whelton A, Fort JG, Puma JA, Normandin D, Bello AE, Verburg KM: Cyclooxygenase-2--specific inhibitors and cardiorenal function: a randomized, controlled trial of celecoxib and rofecoxib in older hypertensive osteoarthritis patients. Am J Ther 2001, 8(2):85-95.
• [10]Davies JG, Rawlins DC, Busson M: Effect of ibuprofen on blood pressure control by propranolol and bendrofluazide. J Int Med Res 1988, 16(3):173-181.
• [11]Wright JT, McKenney JM, Lehany AM, Bryan DL, Cooper LW, Lambert CM: The effect of high-dose short-term ibuprofen on antihypertensive control with hydrochlorothiazide. Clin Pharmacol Ther 1989, 46(4):440-444.
• [12]Klassen D, Goodfriend TL, Schuna AA, Young DY, Peterson CA: Assessment of blood pressure during treatment with naproxen or ibuprofen in hypertensive patients treated with hydrochlorothiazide. J Clin Pharmacol 1993, 33(10):971-978.
• [13]Polonia J, Boaventura I, Gama G, Camoes I, Bernardo F, Andrade P, 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(8):925-931.
• [14]Houston MC, Weir M, Gray J, Ginsberg D, Szeto C, Kaihlenen PM, et al.: The effects of nonsteroidal anti-inflammatory drugs on blood pressures of patients with hypertension controlled by verapamil. Arch Intern Med 1995, 155(10):1049-1054.
• [15]Klassen DK, Jane LH, Young DY, Peterson CA: Assessment of blood pressure during naproxen therapy in hypertensive patients treated with nicardipine. Am J Hypertens 1995, 8(2):146-153.
• [16]Gurwitz JH, Everitt DE, Monane M, Glynn RJ, Choodnovskiy I, Beaudet MP, 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(2):M74-M79.
• [17]Olsen ME, Thomsen T, Hassager C, Ibsen H, Dige-Petersen H: Hemodynamic and renal effects of indomethacin in losartan-treated hypertensive individuals. Am J Hypertens 1999, 12(2):209-216.
• [18]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(11):1161-1167.
• [19]Fogari R, Zoppi A, Carretta R, Veglio F, Salvetti A: Effect of indomethacin on the antihypertensive efficacy of valsartan and lisinopril: a multicentre study. J Hypertens 2002, 20(5):1007-1014.
• [20]Whelton A, White WB, Bello AE, Puma JA, Fort JG: Effects of celecoxib and rofecoxib on blood pressure and edema in patients > or =65 years of age with systemic hypertension and osteoarthritis. Am J Cardiol 2002, 90(9):959-963.
• [21]White WB, Kent J, Taylor A, Verburg KM, Lefkowith JB, Whelton A: Effects of celecoxib on ambulatory blood pressure in hypertensive patients on ACE inhibitors. Hypertension 2002, 39(4):929-934.
• [22]Palmer R, Weiss R, Zusman RM, Haig A, Flavin S, MacDonald B: Effects of nabumetone, celecoxib, and ibuprofen on blood pressure control in hypertensive patients on angiotensin converting enzyme inhibitors. Am J Hypertens 2003, 16(2):135-139.
• [23]Izhar M, Alausa T, Folker A, Hung E, Bakris GL: Effects of COX inhibition on blood pressure and kidney function in ACE inhibitor-treated blacks and hispanics. Hypertension 2004, 43(3):573-577.
• [24]Sowers JR, White WB, Pitt B, Whelton A, Simon LS, Winer N, et al.: The Effects of cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory therapy on 24-hour blood pressure in patients with hypertension, osteoarthritis, and type 2 diabetes mellitus. Arch Intern Med 2005, 165(2):161-168.
• [25]Murray MD, Smith FE, Fox J, Teal EY, Kesterson JG, Stiffler TA, et al.: Structure, functions, and activities of a research support informatics section. J Am Med Inform Assoc 2003, 10(4):389-398.
• [26]Ray WA: Evaluating medication effects outside of clinical trials: new-user designs. Am J Epidemiol 2003, 158(9):915-920.
• [27]American College of Rheumatology Subcommittee on Osteoarthritis Guidelines: Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum 2000, 43(9):1905-1915.
• [28]D’Agostino RB Jr: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998, 17(19):2265-2281.
• [29]Baser O: Too much ado about propensity score models? Comparing methods of propensity score matching. Value Health 2006, 9(6):377-385.
• [30]Zhang J, Yu KF: What’s the Relative Risk. JAMA 1998, 280(19):1690-1691.
• [31]Drug Facts and Comparisons: Facts & Comparisons 4.0. St. Louis, Mo: Wolters Kluwer Health; 2001.
• [32]Tierney WM, Brunt M, Kesterson J, Zhou XH, L’Italien G, Lapuerta P: Quantifying risk of adverse clinical events with one set of vital signs among primary care patients with hypertension. Ann Fam Med 2004, 2(3):209-217.
• [33]Nietert PJ, Ornstein SM, Dickerson LM, Rothenberg RJ: Comparison of changes in blood pressure measurements and antihypertensive therapy in older, hypertensive, ambulatory care patients prescribed celecoxib or rofecoxib. Pharmacotherapy 2003, 23(11):1416-1423.
• [34]Lopez-Ovejero JA, Weber MA, Drayer JI, Sealey JE, Laragh JH: Effects of indomethacin alone and during diuretic or beta-adrenoreceptor-blockade therapy on blood pressure and the renin system in essential hypertension. Clin Sci Mol Med Suppl 1978, 4:203s-205s.
• [35]Johnson AG, Nguyen TV, Day RO: Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis. Ann Intern Med 1994, 121(4):289-300.
• [36]Davis A, Day RO, Begg EJ: Interactions between non-steroidal anti-inflammatory drugs and antihypertensives and diuretics. Aust N Z J Med 1986, 16(4):537-546.
• [37]Epstein M, Oster JR: Beta blockers and renal function: a reappraisal. J Clin Hypertens 1985, 1(1):85-99.
• [38]MacFarlane LL, Orak DJ, Simpson WM: NSAIDs, antihypertensive agents and loss of blood pressure control. Am Fam Physician 1995, 51(4):849-856.
• [39]American Diabetes Association: Standards of medical care in diabetes--2007. Diabetes Care 2007, 30(Suppl 1):S4-S41.
• [40]Grover SA, Coupal L, Zowall H: Treating osteoarthritis with cyclooxygenase-2-specific inhibitors: what are the benefits of avoiding blood pressure destabilization? Hypertension 2005, 45(1):92-97.
• [41]Lewington S, Clarke R, Qizilbash N, Peto R, Collins R: Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002, 360(9349):1903-1913.
• [42]Sudano I, Flammer AJ, Périat D, Enseleit F, Hermann M, Wolfrum M, et al.: Acetaminophen increases blood pressure in patients with coronary artery disease. Circulation 2010, 122(18):1789-1796. Nov 2
• [43]Yood MU, Campbell UB, Rothman KJ, Jick SS, Lang J, Wells KE, et al.: Using prescription claims data for drugs available over-the-counter (OTC). Pharmacoepidemiol Drug Saf 2007, 16(9):961-968.