Nonsteroidal Anti-Inflammatory Drugs and Hypertension

Nonsteroidal anti-inflammatory drugs are among the most widely prescribed medications. Their effect on blood pressure has been monitored, and many small studies have determined a potential relationship between their use and elevation of blood pressure. These drugs may affect blood pressure by inhibiting prostaglandin synthesis, which may affect arteriolar smooth muscle tone and natriuresis. Since many patients with conditions such as osteoarthritis require treatment and also have hypertension, even modest elevations in blood pressure or inhibition of antihypertensive medication efficacy resulting from non steroidal anti-inflammatory drugs can be of significant clinical and public health importance. This review finds that certain drugs (e.g., indomethicin, piroxicam, and naproxen) may cause clinically relevant elevations in blood pressure in hypertensive patients. Aspirin and sulindac do not appear to elevate blood pressure significantly, even in hypertensive patients. Ibuprofen and other nonsteroidal anti-inflammatory drugs appear to have an intermediate blood pressure effect. Cyclo-oxygenase-2 inhibitors such as refecoxib and celecoxib have been shown to cause mild elevations in blood pressure, but further studies are needed to evaluate the full magnitude and population distribution of this effect. (c)2000 by Le Jacq Communications, Inc.