[Untoward interactions between antihypertensives and nonsteroidal anti-inflammatory drugs]

Interactions between antihypertensive agents and nonsteroidal anti-inflammatory drugs (NSAIDs) are often seen in clinical practice. Inhibiting the renal synthesis of vasodilatory prostaglandins and enhancing salt and water retention, NSAIDs increase blood pressure, particularly in hypertensive subjects. Not all NSAIDs are equal in this respect: the highest elevations in mean arterial pressure are reported with indomethacin, naproxen, piroxicam and rofecoxib, while low-dosed aspirin, celecoxib and ibuprofen, are less unwelcome in this respect. The same is true for the antihypertensive drugs: the most prone to the interaction (worsening of blood pressure control) are diuretics and ACE inhibitors, and the most resistant seem to be the calcium channel blockers. Although these claims must be corroborated by further clinical investigations, one of which is under way in Croatia, coprescription of antihypertensives and NSAIDs, particularly to the elderly, in addition to vigilance and care, requires operative knowledge of the therapeutic options.