NSAIDs and blood pressure What are its side effects

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nsaids and blood pressure، NSAIDs are a large group of drugs used to relieve pain (analgesic) and to reduce fever (antipyretic), as well as to reduce inflammation when used over time. Anti-inflammatory effects can take anywhere from a few days to three weeks. The non-selective (traditional) NSAIDs, such as ibuprofen, aspirin, naproxen and nabumetone act by inhibiting both COX-1 and COX-2 to stop the production of prostaglandins, while COX-2 inhibitors only block the COX-enzyme. two. The common uses of NSAIDs are:

nsaids and blood pressure

• The treatment of pain and inflammation associated with arthritis (inflammation and pain resulting from one or more joints, a common feature of more than 200 rheumatic diseases with osteoarthritis (OA) and rheumatoid arthritis (RA) is the most common form ).

• Back pain and sciatica (pain in the leg, which travels below the knee, and may involve the foot, may occur alone or accompanied by lower back pain).

• Sprains, strains and rheumatism (a chronic autoimmune disease with inflammation of the joints and obvious deformities).

• Dental pain

• Post-operative pain

• Menstrual cramps (primary dysmenorrhea – mild, and menorrhagia – heavy).

• The pain of kidney stones (renal colic).

• Reduction of fevers

• Migraines (severe recurrent headaches usually accompanied by an aura (classic migraine), nausea, vomiting and dizziness).

• Other painful conditions, particularly those with symptoms of inflammation.

NSAIDs come in different formulas and over the counter (OTC) and medical prescriptions. Some may work better for you than others. Your doctor can help you find the dose and medication that works best for you. Tell your doctor if you are pregnant, have high blood pressure, have asthma or a history of kidney or liver disease, or have had ulcers in the past. People over 65 years of age should be especially careful when taking NSAIDs. Also tell your doctor about other medications you are taking. NSAIDs can intensify or counteract the effects of some medications. The longer you take it increases the risk and the severity of side effects.

ABSTRACT

Background: An elevation in the risk of cardiovascular (CV) events and blood pressure (BP) levels in patients treated with COX-2 inhibitors compared to non-selective NSAID has been shown previously. Objectives: To compare the effects of NSAID (COX-2 inhibitors and non-selective) on BP levels and control of HT. To determine the association between NSAID use and coronary heart disease in HT patients with elevated CV risk. Methods:

Cross sectional epidemiological study in 8126 ambulatory HT patients, older than 40, with a high CV risk. We obtained data on personal variables, CV risk factors, previous CV history, CV medication, analgesic and anti inflammatory drugs (AID). Control of HT was classified: optimal, suboptimal and not control. Absolute CV risk was calculated according to the WHO-ISH score. Results:
44.2% of subjects took ASA and 3.7% another NSAID. SBP was 5.90 mmHg (95% CI: 2.53-9.27 mmHg) higher (p <0.05) in patients treated with NSAID than in those with no AID medication. Patients having ASA, both SBP and DBP were 5.89 mmHg (p <0.01) and 2.25 mm Hg (p <0.05) respectively, lower than in patients with NSAID. However, mean SBP was similar in the ibuprofen group compared to without AID; 11.12 mmHg lower (95% CI: 3.66-18.58) than in the group on NSAID (p <0.05) and 8.82 mmHg (95% CI: 0.27-17.38) (p <0.05) lower than in those on COX-2 inhibitors. Conclusions:
Among HT patients, NSAID therapy (selective or not) is associated with a higher level of SBP than in those without such medication. However, patients treated exclusively with Ibuprofen show similar levels of SBP than without NSAID treatment. Frequency of ischemic disease was significantly higher in the group treated with COX-2 inhibitors than in the non-selective NSAID treated group or in patients without NSAID treatment.

STUDY DESIGN

Epidemiological, observational, cross-sectional study in the outpatient setting – both specialized care and primary care (PC) – throughout Spain, in a series of hypertensive patients with high CV risk selected consecutively and representing all of these together patients treated in the Spanish public healthcare network.

The present article is based on a subanalysis of the TARVEST project (diagnostic and therapeutic practices in hypertensive patients with high cardiovascular risk in Spain) (13) in which the association of the consumption of different types of NSAIDs with PA levels has been analyzed. the degree of control of it in hypertensive patients with high CV risk in Spain.

SELECTION OF PARTICIPATING PHYSICIANS

From the database of physicians with professional practice in cardiology, general medicine and units / monographic consultations of HA of each health area participating in the TARVEST study, ten PC physicians, two out-of-hospital cardiologists and one physician were chosen at random. unit or monographic consultation of HA. Each physician recruited a minimum of 5 patients to complete the predetermined number of cases.

STUDY POPULATION

The target population was all diabetic hypertensive patients or with concomitant CV disease (ischemic heart disease, cerebral stroke / transient ischemic attack (TIA) or peripheral arterial disease), over 40 years of age, of both sexes, seen in the Spanish public ambulatory network. This group of patients is among the subjects with high CV risk according to the stratification table of WHO and the International Society of Hypertension ( Table I ) (14).

CRITERIA FOR INCLUSION AND EXCLUSION OF PATIENTS

Hypertensive patients according to criterion JNC-VII (15), older than 40 years, who also had at least one of the following conditions: diabetes mellitus, previous history of stroke / TIA, myocardial infarction verified by hospital registry, or history of disease Peripheral arterial occlusion confirmed by an angiologist.

Patients with AMI or recent stroke during the last month, as well as those with symptomatic heart failure, were excluded from the study. Those who had participated in a clinical trial with drugs during the past 3 months, those unable to sign / give informed consent, and patients institutionalized indefinitely in a health-care center were also those.

SELECTION OF THE SAMPLE AND PREDETERMINATION OF THE SAMPLE SIZE

To reach the primary objectives of the TARVEST study, we identified a representative sample of hypertensive patients with high CV risk treated in the public health network (although not necessarily representative of the patients seen in each CC AA or health area). Under these premises it was calculated that a minimum sample of 7,600 patients would be necessary to cover the study objectives. This sample offers a level of statistical security of 95%, both to estimate the percentage of patients in whom an objective evaluation of CV risk was performed, and of patients with adequate treatment to the recommendations of the main therapeutic guidelines.

STUDY VARIABLES

The TARVEST study questionnaire collected sociodemographic data, personal and family history and cardiovascular diseases, presence and control of CV risk factors at the present time, as well as therapeutic recommendations and prescribed treatments.

The information referring to the use of antihypertensive, lipid-lowering, antidiabetic, antiplatelet, anticoagulant and other concomitant medication was sufficiently exhaustive and detailed (therapeutic group, active principle, dose and consumption pattern) to allow a detailed analysis.

Information on the main CV risk factors (diabetes mellitus, hypercholesterolemia, hypertension, smoking and obesity) was based on current international definitions (14-16).

Specifically, for the determination of BP, two measurements were made in the same arm, using a validated automatic sphygmomanometer, after 5 minutes of rest and in sitting. The value of the PA assigned to each subject was the average of the two determinations (15).

Likewise, the degree of control of HA in each individual was determined as: optimal control: systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg; suboptimal control: SBP> 140 mmHg or DBP> 90 mmHg; no control: SBP> 140 mmHg and DBP> 90 mmHg, both at the same time (Table I) (14).

All clinical practice guidelines recommend risk stratification in non-diabetic and diabetic patients. In the latter, optimal control is considered when SBP is <130 mmHg and DBP <85 mmHg; suboptimal control: if SBP> 130 mmHg or DBP> 85 mmHg; no control: when both SBP and DBP are greater than 130 mmHg and 85 mmHg, respectively (16).

Finally, in each individual the individual global risk (absolute risk) of suffering a CV event in 10 years was estimated using the WHO-SIH risk table (14).

QUALITY CONTROL OF DATA COLLECTION

Before the beginning of the study, a pilot study was carried out in 50 cases to verify the applicability of the questionnaire among the preselected researchers for the study. To check the quality of the data recorded by the doctor, a team of independent monitors trained in the handling of the documents and forms carried out a review of medical records in a random sub-sample of 500 patients. A database and a program with an algorithm for the diagnosis of each case and the CV risk assessment were designed.

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