ASK DIS: Drug Interactions : Antihypertensive & NSAIDS

Antihypertensive drugs appear to be affected to variable degrees by NSAIDs.
Diuretics, angiotensin-converting enzyme inhibitors (ACEIs), beta-blockers, and angiotensin II receptor blockers (ARBs) are most susceptible to the hypotensivenullifying effects of NSAIDs.
Calcium channel blockers and centrally acting antihypertensives seem to be least affected.
Although the absolute increase in BP resulting from NSAID coadministration is usually limited to <10 mm Hg, it can result in a 50% reduction in the efficacy of an antihypertensive drug and block the beneficial cardiovascular effects of BP reduction

Posible Mechanism

NSAIDs inhibit prostaglandin-mediated vasodilation and promote salt and water retention.
Both of these mechanisms may contribute to NSAIDs partially reversing the effects of hypotensive drugs, particularly those agents whose mechanism depends on modulating prostaglandins, renin, or sodium and water balance.

Management of Interactions

Short courses of NSAID therapy (ie, less than a week or 2), even with daily NSAID administration, are unlikely to cause a clinically important increase in a patient's BP
Short courses of NSAIDs may cause exacerbation of heart failure. Patients should be counseled to report any symptom changes during NSAID administration.
Low-dose aspirin therapy does not appear to affect the efficacy of antihypertensive drugs or diuretics
Switching to an antihypertensive drug not as susceptible to the blunting effects of NSAIDs should be considered for patients requiring chronic NSAID therapy.
Consider alternative analgesics, such as acetaminophen, tramadol, or narcotic analgesics, for patients requiring analgesics who are unable to have their antihypertensive regimen altered
Monitor BP of patients taking NSAIDs for several weeks to determine if they are candidates for drug regimen adjustments. Also, be alert for signs of fluid retention, such as weight gain or peripheral edema.

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