title: Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension.
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension.
  
  
  METHODS
  We conducted a retrospective cohort study of adult hypertensive patients to determine the effects of their first prescription for NSAID on systolic blood pressure and antihypertensive drug intensification. Data were collected from an electronic medical record serving an academic general medicine practice in Indianapolis, Indiana, USA. Using propensity scores to minimize bias, we matched a cohort of 1,340 users of NSAIDs with 1,340 users of acetaminophen. Propensity score models included covariates likely to affect blood pressure or the use of NSAIDs. The study outcomes were the mean systolic blood pressure measurement after starting NSAIDs and changes in antihypertensive therapy.
  
  
  RESULTS
  Compared to patients using acetaminophen, NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10). The systolic blood pressure increase was 3 mmHg in a subgroup of patients concomitantly prescribed angiotensin converting enzyme inhibitors or calcium channel blockers and 6 mmHg among those prescribed a beta-adrenergic blocker. Blood pressure changes in patients prescribed diuretics or multiple antihypertensives were not statistically significant.
  
  
  CONCLUSIONS
  Compared to acetaminophen, incident use of NSAIDs, particularly ibuprofen, is associated with a small increase in systolic blood pressure in hypertensive patients. Effects in patients prescribed diuretics or multiple antihypertensives are negligible.
authors.affiliation: College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. haljadhey@ksu.edu.sa
authors.forename: Hisham
authors.initials: H
authors.lastname: Aljadhey
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Blalock
authors.forename: D Craig
authors.initials: DC
authors.lastname: Brater
authors.forename: Michael D
authors.initials: MD
authors.lastname: Murray
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D000068579:Celecoxib; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007052:Ibuprofen / Q000627:therapeutic use; D007196:Indiana; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009288:Naproxen / Q000627:therapeutic use; D016017:Odds Ratio; D057216:Propensity Score; D011720:Pyrazoles / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013449:Sulfonamides / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D011720:Pyrazoles; D013449:Sulfonamides; D000082:Acetaminophen; D009288:Naproxen; D000068579:Celecoxib; D007052:Ibuprofen