title: Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients.
abstract: NSAIDs are known to attenuate the effects of some antihypertensive medications. It is not known whether the new class of angiotensin II receptor antagonists is similarly affected. We conducted a multicenter study assessing the effect of indomethacin on the antihypertensive effects of losartan and captopril. After 4 weeks of placebo washout, hypertensive patients received 6 weeks of active antihypertensive therapy with either 50 mg losartan once daily (n=111) or 25 mg captopril twice daily for 1 week, which was increased to 50 mg twice daily for 5 weeks (n=105). This was followed by 1 week of concomitant therapy with indomethacin (75 mg daily). The primary outcome measure was the change in mean 24-hour ambulatory diastolic blood pressure after the addition of indomethacin. Both captopril and losartan significantly lowered ambulatory diastolic blood pressure (losartan -5.3 mm Hg, P:<0.001; captopril -5.6 mm Hg, P:<0.001) after 6 weeks of therapy. Indomethacin significantly attenuated the 24-hour ambulatory diastolic blood pressure for both losartan (2.2 mm Hg, P:<0.05) and captopril (2.7 mm Hg, P:<0.001) and also attenuated the effect of captopril on trough sitting diastolic blood pressure. Changes in daytime diastolic blood pressure (7:00 AM to 11:00 PM) were similar to the 24-hour response in both groups. Nighttime diastolic blood pressure (11:01 PM to 6:59 AM) was significantly attenuated in captopril-treated patients (2.0 mm Hg, P:<0.05), but losartan was unaffected (0.4 mm Hg). Thus, concurrent treatment with indomethacin similarly attenuates the 24-hour antihypertensive response to losartan and captopril.
authors.affiliation: Endocrinology-Hypertension Division, Brigham and Women's Hospital, Medical Service, Brockton/West Roxbury VA Medical Center, and Harvard Medical School, Boston, MA 02115, USA. pconlin@rics.bwh.harvard.edu
authors.forename: P R
authors.initials: PR
authors.lastname: Conlin
authors.forename: T J
authors.initials: TJ
authors.lastname: Moore
authors.forename: S L
authors.initials: SL
authors.lastname: Swartz
authors.forename: E
authors.initials: E
authors.lastname: Barr
authors.forename: L
authors.initials: L
authors.lastname: Gazdick
authors.forename: C
authors.initials: C
authors.lastname: Fletcher
authors.forename: P
authors.initials: P
authors.lastname: DeLucca
authors.forename: L
authors.initials: L
authors.lastname: Demopoulos
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002216:Captopril / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000494:pharmacology*; D002940:Circadian Rhythm; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000494:pharmacology*; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D002216:Captopril; D019808:Losartan; D007213:Indomethacin