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NSAIDs and acetaminophen: Effects on blood pressure and hypertension

Authors
Norman M Kaplan, MD
Raymond R Townsend, MD
Section Editors
Richard H Sterns, MD
George L Bakris, MD
Deputy Editor
John P Forman, MD, MSc

INTRODUCTION

Nonsteroidal anti-inflammatory drugs (NSAIDs) have a variety of adverse effects. From a cardiovascular viewpoint, they can both raise the blood pressure and affect overall cardiovascular risk.

The effect of NSAIDs and acetaminophen on blood pressure and the development of hypertension will be reviewed here. The cardiovascular effects of NSAIDs as well as their adverse effects in patients with chronic kidney disease are discussed separately. (See "Nonselective NSAIDs: Adverse cardiovascular effects" and "COX-2 selective inhibitors: Adverse cardiovascular effects" and "NSAIDs: Acute kidney injury (acute renal failure)".)

EFFECT OF NSAIDS ON BLOOD PRESSURE

All NSAIDs in doses adequate to reduce inflammation and pain can increase blood pressure in both normotensive and hypertensive individuals [1]. The average rise in blood pressure is 3/2 mmHg but varies considerably [2-4]. These effects may contribute to the increase in cardiovascular risk associated with the selective cyclooxygenase-2 (COX-2) inhibitors [5]. (See "COX-2 selective inhibitors: Adverse cardiovascular effects".)

In addition, NSAID use may reduce the effect of all antihypertensive drugs except calcium channel blockers [6]. In addition, a small study of Japanese individuals initiating antihypertensive therapy suggested that the effect of NSAID use on beta-blocker efficacy might also be minimal [7]; in that study, the mean difference in systolic pressure reduction comparing NSAID users and non-users among 364 patients taking beta-blockers was only 0.4 mmHg.

The prohypertensive effect is dose dependent and probably involves inhibition of COX-2 in the kidneys, which reduces sodium excretion and increases intravascular volume [6]. Low-dose aspirin has no COX-2-inhibiting or prohypertensive effects. As an example, 75 mg/day of aspirin did not interfere with antihypertensive therapy, as compared with placebo, in 18,790 patients in the Hypertension Optimal Treatment (HOT) Study [8]. However, these conclusions cannot be extended to larger doses of aspirin.

   

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Literature review current through: May 2016. | This topic last updated: Dec 1, 2015.
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