NSAIO antagonism of antihypertensive therapy

As some non-steroidal anti-inflammatory drugs (NSAIDs) are known to antagonise the action of hypertensive drugs and approximately 30% of patients with arthritis are also treated for hypertension, there is a high risk of a serious interaction occurring .

The potential of indomethacin to antagonise antihypertensive therapy has been 'extensively evaluated '; indomethacin has been shown to block the eHect of beta-blockers, diuretics and angiotensin-converting enzyme (ACE) inhibitors and to increase arterial pressure in patients receiving diuretic treatment in addition to other antihypertensive agents However, neither suhndac nor aspinn have these effects . Other NSAIDs have not been studied as extensively but p,rox,cam IS known to Increase artenal pressure In patients treated with antihypertensives, while naproxen IS thought to have an action similar to Indomethacin The effects of asplnn and sullndac on blood pressure differ from Indomethacin even though all 3 agents are cyclooxygenase Inhibitors

As yet , the mechanism of SAID antagonism of ant ihypertensive drug acllon , the reason for between patient vanability In the magnitude of hypertension evoked by Indomethacin and the factors determining patient susceptibility to the hypertensive effects of Indomethacin and other NSAIDs have not been elucidated. Until these factors are determined asplnn and sullndac remain the safest NSAIDs for use with concomitant antihypertensive therapy Patient and prescnber educallon to minimise the incidences of adverse reactions IS particularly Important as m any 'at nsk ' patients are under the care of more than 1 phYSICian and many more have increasing access to over-the-counter non-steroidal antI-Inflammatory drugs Oates JA HypertenSIon 11 (Suppl I!) 46. Mar 1988

2 REACTIONS 13 Aug 1988 0157-7271 / 88/ 0813-0002/ 0$01 .00/ 0 ct> ADIS Press