Treatment of osteoarthritis in hypertensive patients.
BACKGROUND
Osteoarthritis and hypertension commonly co-exist. Treatment of osteoarthritis in hypertensive patients is a therapeutic challenge due to the adverse effects of some analgesics, especially non-steroidal anti-inflammatory drugs (NSAIDs), on blood pressure. Even small drug-induced rises in blood pressure due to therapy may significantly increase cardiovascular risk in these patients if sustained over the long term. Patients treated with certain classes of antihypertensive agent may be at particular risk of deterioration in blood pressure control with NSAID therapy. NSAIDs may also increase cardiovascular risk due to mechanisms other than by raising blood pressure.


METHODS
We discuss the management of osteoarthritis in the hypertensive patient, review the evidence for the effects of paracetamol and NSAIDs on blood pressure and discuss novel therapeutic strategies for osteoarthritis that might diminish this problem. A literature search was undertaken in PubMed including the years 1980 - 2009.


RESULTS
Insight will be gained into the complexity of treating patients with co-existent osteoarthritis and hypertension and into possible new approaches to treating osteoarthritis symptoms effectively in these patients while minimising any adverse impact on blood pressure control.


CONCLUSIONS
There are ways to minimise the adverse impact of treatment of osteoarthritis on blood pressure control in hypertensive patients.
Mackenzie
Isla S
IS
University of Dundee, Ninewells Hospital, Hypertension Research Centre and Medicines Monitoring Unit, Level 7, Dundee DD1 9SY, UK. i.s.mackenzie@dundee.ac.uk
MacDonald
Thomas M
TM
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D017281:Cost of Illness; D004730:Endothelium, Vascular / Q000187:drug effects; D015444:Exercise / Q000502:physiology; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D009569:Nitric Oxide / Q000378:metabolism; D010003:Osteoarthritis / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D018501:Antirheumatic Agents; D009569:Nitric Oxide