NSAIDs, hypertensjon og kardiovaskulære hendelser

Abstract

ABSTRACT Objective A literature review of the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure and cardiovascular risk.

Background NSAIDs are used for relieving pain in many conditions. They can lead to serious gastrointestinal adverse effects, which limits their use. This has led to development of selective cyclo-oxygenase-2 inhibitors (coxibs), a new class of drugs with equivalent analgesic and anti-inflammatory efficacy to NSAIDs, but with more favorable gastrointestinal safety profile. Since clinical trials have documented an increased risk of cardiovascular events with the use of coxibs, attention is now focused on possible cardiovascular risks associated with the use of NSAIDs.

Methods A literature search in Medline of published English-language studies of NSAIDs and their effects on blood pressure and cardiovascular risk was done.

Results The effect of NSAIDs on blood pressure seems to be limited to hypertensive subjects and subjects that are being treated with antihypertensive agents. Studies of NSAIDs’ effect on cardiovascular risk indicate an increased risk of cardiovascular disease with the usage of diclofenac and high doses of ibuprofen. Furthermore, a cardiovascular risk associated with the use of naproxen cannot be ruled out.

Conclusions NSAIDs increase the blood pressure significantly and antagonize the effect of most antihypertensive drugs. This effect seems to have clinical relevance for special groups, such as the elderly, and patients with hypertension. The cardiovascular risk of NSAIDs is less clear, but an increase in blood pressure is in itself a risk factor for developing cardiovascular events.