Defining the problem of treating the patient with hypertension and arthritis pain

As osteoarthritis and hypertension coexist often in patients aged >60 years, the coadministration of nonsteroidal anti-inflammatory drugs (NSAIDs) with hypertension therapies is common practice in clinical medicine. Clinical trials in patients with arthritis have shown that many agents within the NSAID class may induce significant increases in systolic blood pressure, particularly when patients are using renin-angiotensin-blocking agents, beta-blockers, or diuretics as antihypertensives. The increases in blood pressure caused by NSAIDs are large enough to be of clinical concern. Sustained blood pressure elevations in the elderly are associated with increases in the risk of both ischemic and hemorrhagic stroke, congestive heart failure, and ischemic cardiac events. Recognition of the development of destabilization of blood pressure control in clinical practice and an awareness of those NSAIDs that place patients at risk for the development of hypertension could lead to reductions in cardiovascular morbidity.