18/07/2024
🔴 EFFECT OF NSAIDS ON BP AND MANAGEMENT OF PATIENTS TAKING NSAIDS
🔷️ All nonsteroidal antiinflammatory drugs (NSAIDs) in doses adequate to reduce inflammation and pain can increase blood pressure in both normotensive and hypertensive individuals.
🔷️The prohypertensive effect is dose dependent and probably involves inhibition of COX-2 in the kidneys, which reduces sodium excretion and increases intravascular volume.
🔷️In addition, NSAID use may reduce the effect of all antihypertensive drugs except calcium channel blockers, Probably the main mechanism of action is inhibition of prostaglandin (PG) synthesis since PG enhances vasodilatation and attenuates vasoconstrictor influences.
🔷️ NSAIDs have higher propensity to increase BP as the regulation of BP (and renal function) is more PG-dependent and interact with drugs (diuretics, beta-blockers and ACE inhibitors) that may act through the increase of PG formation.
🔴MANAGEMENT OF HYPERTENSIVE PATIENTS TAKING NSAIDS
🔷️Many hypertensive patients require chronic analgesic therapy with nonsteroidal antiinflammatory drugs (NSAIDs) in order to treat chronic pain (eg, due to osteoarthritis). In one large cohort, for example, more than 50 percent of hypertensive patients were prescribed NSAIDs or acetaminophen , attention should be paid to the following aspects of care:
🔷️With the possible exception of calcium channel blockers and central acting drugs
NSAIDs can inhibit the effectiveness of most antihypertensive drugs. Thus, use of a dihydropyridine calcium channel blocker (eg, amlodipine), which is acceptable first-line therapy in the treatment of hypertension, may simplify the management of such patients.
🔷️More frequent monitoring of blood pressure, including home monitoring, may be required, particularly if patients change analgesics or analgesic doses.
🔷️NSAIDs can cause an acute deterioration in glomerular filtration rate; no single NSAID appears safer than the others. Patients taking antihypertensive medications who initiate NSAID therapy should have their serum creatinine monitored at two- to four-week intervals until it is certain that it is stable. Most kidney effects of NSAIDs should be apparent in the first month. Thereafter, we monitor the serum creatinine up to 6 to 12 months or if there is a change in the dose of NSAID therapy.
🔷️NSAIDS increase blood pressure at least in part by reducing sodium excretion by the kidney. Thus, it is important to remind hypertensive patients taking chronic NSAID therapy to limit their sodium intake.
🔷️https://www.uptodate.com/contents/nsaids-and-acetaminophen-effects-on-blood-pressure-and-hypertension?topicRef=3819&source=see_link
https://pubmed.ncbi.nlm.nih.gov/9397294/ #:~:text=Nonsteroidal%20anti%2Dinflammatory%20drugs%20(NSAIDs,efficacy%20of%20several%20antihypertensive%20drugs.
