Advances in Clinical and Experimental Medicine

Adv Clin Exp
Impact Factor (IF) – 1.179
Index Copernicus (ICV) – 169.43, MNiSW – 15
Rejection rate – 65.13%
License – Creative Commons (CC BY-NC-ND 4.0)
ISSN 1899–5276 (print),   ISSN 2451-2680 (online)
Periodicity – monthly

Download PDF

Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 6, November-December, p. 993–1000

Publication type: review article

Language: English

The Impact of Combinations of Non-Steroidal Anti-Inflammatory Drugs and Anti-Hypertensive Agents on Blood Pressure

Stanislava Kalafutova1,A,B,C,D,F, Bozena Juraskova2,E,F, Bozena Juraskova3,E,F, Jiri Vlcek1,E,F

1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, The Czech Republic

2 Sub-Department of Gerontology, Faculty of Medicine in Hradec Kralove, Charles University in Prague, The Czech Republic

3 3rd Clinic of Internal Medicine, Metabolism and Gerontology, University Hospital Hradec Kralove, The Czech Republic


Nowadays NSAIDs are the most frequently used groups of drugs, especially because of their availability. Their consumption is high among older people, who are much more sensitive to the side effects, and who are often also taking other drugs which can interact with them. Moreover, the majority of the older population is suffering from hypertension. This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice. The severity of this drug interaction is classified as class C, with a recommendation to monitor therapy. However, even a minor long-term increase in blood pressure can significantly increase the risk of cardiovascular mortality, while mortality rates can possibly be reduced by sufficiently effective treatment of hypertension. Therefore, in clinical practice, this type of interaction should not be overlooked as a major cause of failure of hypertension treatment in older patients, as well in many cases in general. The present article focusses on the mechanism and the degree of influence on the blood pressure of particular types of antihypertensive agents used in combination with NSAID. Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all. Similarly, not every NSAID increases blood pressure. Many studies, some of which are analyzed in this article, present evidence of the degree of the influence NSAIDs have on blood pressure.

Key words

antihypertensive drugs, non-steroidal anti-inflammatory drugs, blood pressure, hypertension.

References (40)

  1. Grundmann M, Kacířová I: Combination therapy for hypertension. Ambulantná terapia 2007, 5, 106–110.
  2. Cífková R: Hypertension in the elderly. Kap Kardiol 2012, 4, 9–13.
  3. Juszczyk Z: Systolic hypertension in older persons – Controversies and indications for treatment. Adv Clin Exp Med 2006, 15, 521–526.
  4. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ, HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008, 358, 1887–1898.
  5. Bacic-Vrca V, Marusic S, Erdeljic V, Falamic S, Gojo-Tomic N, Rahelic D: The incidence of potential drug-drug interactions in elderly patients with arterial hypertension. Pharm world Sci 2010, 32, 815–821.
  6. Johnson AG: NSAIDs and blood pressure. Clinical importance for older patients. Drugs Aging 1998, 12, 17–27.
  7. Frishman WH: Effects of Nonsteroidal Anti-Inflammatory Drug Therapy on Blood pressure and Peripheral Edema. Am J Cardiol 2002, 89, 18–25.
  8. Halawa B: Unresolved problems in hypertension treatment. Adv Clin Exp Med 2001, 10, 115–119.
  9. Vondráčková D: Treatment of pain in elderly patients. Čes Ger Rev 2004, 1, 28–36.
  10. Armstrong EP, Malone DC: The impact of nonsteroidal anti-inflammatory drugs on blood pressure, with an emphasis on newer agents. Clin Ther 2003, 25, 1–18.
  11. Vondráčková D: Treatment of nonmalignant pain in geriatric patients opioids. Čes Ger Rev 2008, 6, 103–108.
  12. Auret K, Schug SA: Underutilisation of opioids in elderly patients with chronic pain: approaches to correcting the problem. Drugs Aging 2005, 22, 641–654.
  13. Nasjletti A: Arthur C. Corcoran Memorial Lecture. The role of eicosanoids in angiotensin-dependent hypertension. Hypertension 1998, 31, 194–200.
  14. Schlondorff D: Renal complications of nonsteroidal anti-inflammatory drugs. Kidney Int 1993, 44, 643–653.
  15. Smith MC, Dunn MJ: The role of prostaglandins in human hypertension. Am J Kidney Dis 1985, 5, 32–39.
  16. Wilson SL, Poulter NR: The effect of non-steroidal anti-inflammatory drugs and other commonly used nonnarcotic analgesics on blood pressure level in adults. J Hypertens 2006, 24, 1457–1469.
  17. Gaziano JM: Nonnarcotic Analgesics and Hypertension. Am J Cardiol 2006, 97, 10–16.
  18. Zadražil J: Nonsteroidal antiinflammatory drugs and the kidney. Vnitř Lék 2006, 52, 7–8.
  19. Pavlicević I, Kuzmanić M, Rumboldt M, Rumboldt Z: Interaction between antihypertensives and NSAIDs in primary care: a controlled trial. Can J Clin Pharmacol 2008, 15, 372–382.
  20. Hersh EV, Pinto A, Moore PA: Adverse drug interactions involving common prescription and over-the-counter analgesic agents. Clin Ther 2007, 29, 2477–2497.
  21. Ruoff GE: The impact of nonsteroidal anti-inflammatory drugs on hypertension: alternative analgesics for patients at risk. Clin Ther 1998, 20, 376–387.
  22. Ishiguro C, Fujita T, Omori T, Fujii Y, Mayama T, Sato T: Assessing the effects of non-steroidal anti-inflammatory drugs on antihypertensive drug therapy using post-marketing surveillance database. J Epidemiol 2008, 18, 119–124.
  23. Favre L, Glasson P, Riondel A, Vallotton MB: Interaction of diuretics and non-steroidal anti-inflammatory drugs in man. Clin Sci (Lond) 1983, 64, 407–415.
  24. Herchuelz A, Derenne F, Deger F, Juvent M, Van Ganse E, Staroukine M, Verniory A, Boeynaems JM, Douchamps J: Interaction between nonsteroidal anti-inflammatory drugs and loop diuretics: modulation by sodium balance. J Pharmacol Exp Ther 1989, 248, 1175–1181.
  25. Mason RP, Giles TD, Sowers JR: Evolving mechanisms of action of beta blockers: focus on nebivolol. J Cardiovasc Pharmacol 2009, 54, 123–128.
  26. Whelton A: Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications. Am J Med 1999, 106, 13–24.
  27. Johnson AG, Nguyen TV, Day RO: Do nonsteroidal anti-inflammatory drugs affect blood pressure? A metaanalysis. Ann Intern Med 1994, 121, 289–300.
  28. MacDonald TM, Richard D, Lheritier K, Krammer G: The effects of lumiracoxib 100 mg once daily vs. ibuprofen 600 mg three times daily on the blood pressure profiles of hypertensive osteoarthritis patients taking different classes of antihypertensive agents. Int J Clin Pract 2010, 64, 746–755.
  29. Conlin PR, Moore TJ, Swartz SL, Barr E, Gazdick L, Fletcher C, DeLucca P, Demopoulos L: Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension 2000, 36, 461–465.
  30. Oral I: Medicaments reducing the effectiveness of antihypertensive drugs. Klin Farmakol Farm 2004, 18, 22–25.
  31. Schmieder RE: Mechanisms for the clinical benefits of angiotensin II receptor blockers. Am J Hypertens 2005, 18, 720–730.
  32. Salort-Llorca C, Mínguez-Serra MP, Silvestre-Donat FJ: Interactions between ibuprofen and antihypertensive drugs: incidence and clinical relevance in dental practice. Med Oral Patol Oral Cir Bucal 2008, 13, 717–721.
  33. Perlík F, Lincová D, Fendrich Z: Substances affecting the cardiovascular and renal systems. In: Basic and Applied Pharmacology. Second, supplemented and revised edition. Eds.: Lincová D, Farghali H, Galén Prague 2007, 2nd ed., 219–269.
  34. Polónia J, Boaventura I, Gama G, Camões I, Bernardo F, Andrade P, Nunes JP, Brandão F, Cerqueira-Gomes M: Influence of non-steroidal anti-inflammatory drugs on renal function and 24h ambulatory blood pressure-reducing effects of enalapril and nifedipine gastrointestinal therapeutic system in hypertensive patients. J Hypertens 1995, 13, 925–931.
  35. Morgan T, Anderson A: Interaction of indomethacin with felodipine and enalapril. J Hypertens 1993, 11, 338–339.
  36. Morgan T, Anderson A: The effect of nonsteroidal anti-inflammatory drugs on blood pressure in patients treated with different antihypertensive drugs. J Clin Hypertens (Greenwich) 2003, 5, 53–57.
  37. Aw TJ, Haas SJ, Liew D, Krum H: Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Arch Intern Med 2005, 165, 490–496.
  38. Pope JE, Anderson JJ, Felson DT: A meta-analysis of the effects of nonsteroidal anti-inflammatory drugs on blood pressure. Arch Intern Med 1993, 153, 477–484.
  39. Sowers JR, White WB, Pitt B, Whelton A, Simon LS, Winer N, Kivitz A, van Ingen H, Brabant T, Fort JG, Celecoxib Rofecoxib Efficacy and Safety in Comorbidities Evaluation Trial (CRESCENT) Investigators: The Effects of cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory therapy on 24-hour blood pressure in patients with hypertension, osteoarthritis, and type 2 diabetes mellitus. Arch Intern Med 2005, 165, 161–168.
  40. Johnson AG, Simons LA, Simons J, Friedlander Y, McCallum J: Non-steroidal anti-inflammatory drugs and hypertension in the elderly: a community-based cross-sectional study. Br J Clin Pharmacol 1993, 35, 455–459.