Is it okay for HYPERtensive patients to take NSAIDs?
Is it okay for patients with hypertension to take NSAIDs e.g., ibuprofen, celecoxib, etc? ― Many can, but you need to be careful...
On average, NSAIDs increase blood pressure (BP) by around 5 mmHg in patients with hypertension, but some patients are more susceptible than others. Elevations are more likely in the elderly, obese men and patients with diabetes, heart failure, or kidney or liver disease.
Tell patients with uncomplicated hypertension that occasional use of NSAIDs is usually okay, but daily use for just one week can reduce blood pressure control. Monitor blood pressure if a hypertensive patient starts a chronic NSAID. Explain that NSAIDs can also make antihypertensive medications less effective. Be careful about combining an NSAID with an ACE inhibitor or ARB, the combo can worsen blood pressure and renal function.
And watch for the "triple whammy", an NSAID plus an ACEI or ARB plus a diuretic. This combo can push a patient into acute renal failure. Consider using a calcium channel blocker (amlodipine) if a patient needs an antihypertensive that is less affected by NSAIDs.
Don't expect one NSAID to increase blood pressure more or less than the others. Suggest naproxen (Naprofen) if a chronic NSAID is needed for a patient with cardiovascular disease, not just hypertension. Naproxen seems to be the least likely to increase cardiovascular risk.
References
- Snowden S, Nelson R. The effects of nonsteroidal anti-inflammatory drugs on blood pressure in hypertensive patients. Cardiol Rev. 2011 Jul-Aug;19(4):184-91.
- Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, Jüni P. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011 Jan 11;342:c7086.