The Effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) on Blood Pressure in Patients with Hypertension

Dysregulation of blood pressure control in hypertensive patients using nonsteroidal anti-inflammatory drugs (NSAIDs) could increase morbidity, mortality, and health care costs. The aims of this research were to examine the association between NSAIDs and blood pressure in hypertensive patients, compare the effects of various NSAIDs on blood pressure, and determine if NSAIDs were associated with changes in antihypertensive therapy. This retrospective cohort study included hypertensive patients who received their first prescription for any NSAID and met the inclusion criteria. Patients included in this research received their care from the medicine practice clinics at Wishard Health Services in Indianapolis, Indiana between 1993 and 2006. Patients were followed for one year after the first prescription or 30 days after the last prescription that was dispensed, whichever was less. Patients meeting the same criteria but who were prescribed acetaminophen formed the control group. The primary outcomes were first systolic blood pressure and intensification of antihypertensive therapy. Covariates affecting blood pressure or the prescribing of NSAIDs were included in the statistical models. Propensity score matching techniques were used to balance background characteristics between comparison groups. A total of 3,928 eligible patients were prescribed NSAIDs or acetaminophen. Compared to acetaminophen, prescription for NSAID was associated with a 2 mmHg increase in systolic blood pressure (P = 0.004), and a 6 mmHg increase in those concurrently prescribed beta-adrenergic blocker (P = 0.008). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (P = 0.015), and a 5 mmHg increase compared to celecoxib (P = 0.035). Ibuprofen was associated with a higher risk of systolic blood pressure increase of ≥ 20 mmHg compared to naproxen (odds ratio, 1.57; 95% confidence interval, 1.10 to 2.25; P = 0.014). Dose effects were not observed for either ibuprofen or naproxen. There was no evidence of intensification in antihypertensive therapy in patients prescribed NSAIDs. In conclusion, NSAIDs were associated with a small increase in systolic blood pressure in hypertensive patients compared to acetaminophen. The increase in systolic blood pressure from NSAIDs did not increase the risk of intensification of antihypertensive treatment. Confirmatory studies will be needed to affirm these results.Doctor of Philosoph