August 31st, 2015
NSAIDs are one of the most commonly prescribed medicines, In fact, according to statistics NSAIDs are prescribed to one in every 20 patients visiting their doctors. Statistics also point out that one in every three adult American is hypertensive. Given such a scenario, it is a pertinent question to ask that whether patients suffering from hypertension should take NSAIDs concomitantly.
We know that NSAIDs increase the risk of gastrointestinal bleeding and cardiovascular events. However, we often fail to notice that the labels on NSAIDs warn that these medicines can cause development of high blood pressure in previously normotensive patients and worsening of hypertension in patients who already suffer from high blood pressure.
It has been seen that use of NSAIDs can increase the blood pressure by 1 mm of Hg in people who do not suffer from high blood pressure. This increase can be up to 5-6 mm of Hg in patients who are already suffering from hypertension. How
ever, this increase varies from person to person. The increase is more prominent in individuals who are obese, are elderly, or suffering from other concurrent diseases like diabetes, heart failure, and diseases of the liver or kidneys.
Increase in blood pressure is seen within a week of regular use of NSAIDs. Moreover, this increase is directly proportional tothe dose of NSAIDs.
An increase in the diastolic blood pressure by 5 to 6 mm of Hg when maintained over several years can lead to a 67% increase in the risk of developing stroke and 15% increase in the risk of developing coronary heart disease conditions.
There are several ways by which use of NSAIDs can lead to rise in blood pressure. They are:
The efficacy of several medicines used to treat high blood pressure is altered with the concurrent use of NSAIDs. The medicines whose actions are most likely to be affected by NSAIDs include ACE inhibitors, Angiotensin receptor blockers (ARBs), beta blockers and diuretics.
The actions of calcium channel blockers and centrally acting adrenergic medicines like clonidine are the least likely to be affected by NSAIDs.
Therefore, if concomitant use of blood pressure medicines and NSAIDs cannot be avoided, it is advisable to use calcium channel blockers or centrally acting adrenergic medicines.
Apart from low dose aspirin (81 mg per day), all other NSAIDs have been found to be associated with an increase in the blood pressure. Even topical NSAIDs can also lead to an increase in blood pressure.
Naproxen is the safest NSAID as far as the risk of cardiovascular events like heart attack and stroke is concerned. Diclofenac and celecoxib have the highest cardiovascular risk.
However, naproxen is the most likely to damage the kidneys on prolonged use. Indomethacin, naproxen and piroxicam cause a higher rise in blood pressure compared to other NSAIDs.
“NSAIDs and increased blood pressure- What is the clinical significance?” by Johnson AG. Published in the November 1997 issue of the journal Drug Safety, accessed on August 10, 2015. Retrieved from:
Schedule your private consultation with Dr. Elist
Through experience, empathy, and patient empowerment, Dr. Elist offers a comprehensive and detail-oriented treatment plan for every patient. Schedule your consultation to discuss treatments for men in Los Angeles with premier surgeon Dr. James Elist, and begin your journey confident that your best results are just ahead of you.