Assessing the effects of non-steroidal anti-inflammatory drugs on antihypertensive drug therapy using post-marketing surveillance database.
BACKGROUND
Antihypertensive and non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat many common diseases. However, it has been suspected that interactions between these drugs exist. Here, we assessed the interactions between non-selective NSAIDs and several classes of antihypertensive drugs.


METHODS
The study design was a cohort study using "The Antihypertensive Drug Database," which is a collection of data accumulated from Drug Use Investigations. Subjects newly starting antihypertensive drug therapy were identified in the database. We compared the "User" group, who were co-administered NSAIDs, with the "Non-user" group, who were not. The outcome measure was the change in systolic blood pressure from the baseline after 2 months of treatment. We estimated the non-adjusted and adjusted differences in the change in systolic blood pressure between the "User" and "Non-user" groups.


RESULTS
Data were collected for a total of 1,204 subjects, of whom 364 were prescribed beta blockers, 60 were prescribed diuretics, 628 were prescribed angiotensin-converting enzyme inhibitors, and 152 were prescribed calcium channel blockers. The adjusted difference in the change in systolic blood pressure between the User (n = 301) and Non-user (n = 903) groups was 2.88 mmHg (95% confidence interval: 0.89, 4.87); thus, systolic blood pressure in the Non-User group decreased further from the baseline than that in the User group. In subjects administered beta blockers, diuretics, angiotensin-converting enzyme inhibitors, and calcium channel blockers, the corresponding differences were 0.37 mmHg (-3.24, 3.98), 6.11 mmHg (-3.16, 15.37), 3.85 mmHg (1.16, 6.66), and 3.50 mmHg (-2.03, 9.02).


CONCLUSIONS
The effectiveness of antihypertensive drugs was attenuated by the co-administration of NSAIDs. The differences in the effects of NSAIDs varied with different classes of antihypertensive drugs.
Ishiguro
Chieko
C
Office of Safety, Pharmaceutical and Medical Devices Agency, Shin-kasumigaseki Building 3-3-2, Kasumigaseki, Chiyodaku, Tokyo 100-0013, Japan. ishiguro-chieko@pmda.go.jp
Fujita
Toshiharu
T
Omori
Takashi
T
Fujii
Yosuke
Y
Mayama
Takeshi
T
Sato
Tosiya
T
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000494:pharmacology*; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000037:antagonists & inhibitors*; D001168:Arthritis / Q000150:complications / Q000188:drug therapy*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000494:pharmacology; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D004232:Diuretics / Q000008:administration & dosage / Q000037:antagonists & inhibitors; D004336:Drug Antagonism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics