NSAIDs Raise Blood Pressure Unpredictably Over Time


ORLANDO — Chronic use of nonsteroidal anti-inflammatory agents promotes sodium-retention weight gain and can cause blood pressure to rise by an average of 5 mm Hg, Dr. Matthew R. Weir said at a meeting sponsored by the National Kidney Foundation.

The increase is “not insignificant” when one considers how widely used these drugs are, said Dr. Weir, professor of medicine at the University of Maryland, Baltimore.

Most clinicians are familiar with the renal syndromes caused by NSAIDs and tend to be concerned about kidney disease or dysfunction. But these effects tend to be reversible.

The effects of NSAIDs on blood pressure may pose a more serious issue, Dr. Weir said. “One has to view NSAIDs as antinatriuretic compounds. This is a concern because, depending on how much salt you eat, the actual dose of the NSAID you are taking, and your preexisting levels of blood pressure, you can get very different effects on overall changes in blood pressure over time.”

The age-related changes in renal blood supply that occur over time may be an important issue in older patients, who are more likely to be using NSAIDs to relieve the pain of chronic conditions such as arthritis.

To avoid adverse cardiovascular effects, always use the lowest possible dose of anti-inflammatory drug, regardless of class. Consider using shorter-acting agents, which may allow the kidney to restore its sodium and water balance, he advised.

Counsel patients taking NSAIDs to try to avoid dietary sodium. “Quite clearly, when you give chemicals that engender sodium sensitivity … you should tell your patients that they really need to avoid dietary sodium as best they can,” said Dr. Weir.

Blood pressure must be monitored carefully in persons taking NSAIDs, and blood pressure medications adjusted accordingly. Calcium channel blockers in particular appear to retain their lowering effect on blood pressure despite chronic NSAID use.

“We are not sure why, but calcium channel blockers may have natriuretic properties that are independent of so-called prostaglandin-dependent mechanisms within the kidney. We studied this years ago and found that calcium channel blockers helped alleviate any blood pressure-associated change with nonsteroidal anti-inflammatory drugs,” Dr. Weir said.

Nonprescription drugs should not be overlooked, he added. “We should take a careful history on the use of over-the-counter NSAIDs. They don't often appear on medication lists.”

Calcium channel blockers have been shown to help alleviate any blood pressure-related change with NSAIDs. DR. WEIR

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