The impact of nonsteroidal anti-inflammatory drugs on blood pressure, with an emphasis on newer agents.
BACKGROUND
Both nonselective and selective nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to increase blood pressure (BP).


OBJECTIVE
This review summarizes the most recent data regarding the BP changes that may occur with routine dosing of nonselective or selective NSAIDs, with a focus on the latter. The review includes both clinical trials and studies having more naturalistic designs.


METHODS
Relevant articles were identified through a search of MEDLINE emphasizing NSAIDs and hypertension.


RESULTS
It is well established that NSAIDs increase BP in certain patients. Patients with existing hypertension seem to be at greatest risk for this adverse event. There seem to be differences between nonselective NSAIDs with regard to their effect on BP; indomethacin, naproxen, and piroxicam have been associated with clinically significant changes in BP. Most of the available evidence concerning the selective NSAIDs suggests that rofecoxib is more likely than celecoxib to raise systolic BP. Based on the results of trials in the treatment of BP, increases in systolic BP produced by these NSAIDs may be associated with significant morbidity and mortality. The adverse effects of NSAIDs on BP may be related to the specific drug or to the dose or duration of therapy, as well as to patient-specific characteristics.


CONCLUSIONS
Clinically significant BP changes may occur after treatment with either nonselective or selective NSAIDs. The observed BP changes are not the same for all products, however.
Armstrong
Edward P
EP
College of Pharmacy, University of Arizona, Tuczon, AZ 85721, USA. Armstrong@pharmacy.arizona.edu
Malone
Daniel C
DC
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D002986:Clinical Trials as Topic; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases