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15 August 1994 | Volume 121 Issue 4 | Pages 289-300
Purpose: A meta-analysis of randomized trials studying the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure.
Data Sources and Study Selection: Eight databases were searched, yielding 38 randomized, placebo-controlled trials and 12 randomized but not placebo-controlled trials (comparing two or more NSAIDs).
Data Extraction: Pooled mean treatment effects were computed in each trial for blood pressure, weight, creatinine clearance, plasma renin activity, and daily urinary excretion of sodium and prostaglandins. Meta-analyses of these variables were done for all randomized, controlled trials; for all randomized, uncontrolled trials; and for several subgroups.
Data Synthesis: When pooled, NSAIDs elevated supine mean blood pressure by 5.0 mm Hg (95% CI, 1.2 to 8.7 mm Hg) but had no effect on variables other than blood pressure. Nonsteroidal anti-inflammatory drugs antagonized the antihypertensive effect of ß-blockers (blood pressure elevation, 6.2 mm Hg; CI, 1.1 to 11.4 mm Hg) more than did vasodilators and diuretics. Among NSAIDs, piroxicam produced the most marked elevation in blood pressure (6.2 mm Hg; CI, 0.8 to 11.5 mm Hg), whereas sulindac and aspirin had the least hypertensive effect.
Conclusions: Nonsteroidal anti-inflammatory drugs may elevate blood pressure and antagonize the blood pressure-lowering effect of antihypertensive medication to an extent that may potentially increase hypertension-related morbidity. Although certain NSAIDs and antihypertensive agents could be more likely to produce these effects, the underlying mechanisms require further study.
Author and Article Information
From St. Vincents Hospital and the University of New South Wales, Sydney, Australia.
REVIEW
Do Nonsteroidal Anti-inflammatory Drugs Affect Blood Pressure? A Meta-Analysis
Requests for Reprints: Anthony G. Johnson, MBBS, FRACP, Department of Clinical Pharmacology, Princess Alexandra Hospital, Woolloongabba 4102 Qld Australia.
Acknowledgments: The authors thank Dr. Robert Cummings for his comments and the Clinical Trials Coordinator, Suzanne Duffy, for her assistance with the blinding process.
Grant Support: Dr. Johnson was a National Health & Medical Research Council of Australia scholar.
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