engleski

Peculiarities of the interaction between antihypertensive and antirheumatic drugs.

Objectives: To test the hypothesis that non-steroidal anti-inflammatory drugs (NSAIDs) vary in their interactive propensity with antihypertensive agents to impair the control of elevated blood pressure (BP). Methods: A prospective, parallel group clinical trial in a family practice setting in Split, Croatia, included 88 treated hypertensive subjects of either gender above the age of 55 years ; 39 controls and 49 taking NSAIDs for osteoarthritis. In a factorial design compared were 2 antihypertensives: lisinopril/hydrochlorothiazide combination (L/H) and amlodipine (AM) with 3 NSAIDs: ibuprofen (IB), paracetamol (PC), and piroxicam (PX). The antihypertensive treatment was unchanged during this 3-month study, while the NSAID medication was split in 3 monthly blocks (IB or PX &#8211; PC &#8211; the first NSAID again). Results: The standing blood pressure at the inception of this study was 148.6&#177; 10.6/89.2&#177; 7.1 mm Hg in the control group, and 149.3&#177; 9.8/88.7&#177; 6.8 mm Hg in the study group. In the L/H subgroup IB and PX elevated systolic BP by 7.7-9.9% (p<0.001), which during PC period decreased by 6.9-9.4%, i.e. to 0.3-0.9% above baseline (p<0.001 vs. IB/PX period), increasing again by 7.0-7.7% (p<0.001) during the second exposition. In the AM subgroup IB or PX increased SBP by 1.1-1.6% (p>0.290) only, with insignificant changes during the PC or the second IB or PX period. Similar alterations were observed in diastolic BP as well. In the control group BP did not fluctuate appreciably during this study. Conclusion: NSAIDs indeed blunt the effects of antihypertensive drugs but not to the same extent: PX is marginally exceeding IB in this respect, while PC is almost inert. L/H is much more affected by the interaction than AM. Clinical implications of the observed phenomena are self-evident.

non-steroidal anti-inflammatory drugs; antihypertensive drugs; interaction; primary care

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