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Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

Non-steroidal anti-inflammatory drugs (NSAIDs) are known to antagonize the effects of antihypertensive drugs, and these associations can lead to an increase in arterial blood pressure. However, the impact of NSAIDs on hypertension treatment management in large-scale populations remains poorly evaluated. We examined whether the introduction of NSAID into the treatment regimen would induce an intensification of hypertension treatment (defined as the introduction of a new antihypertensive drug).

Methods

We conducted a cohort study involving 5,710 hypertensive subjects included in the French health insurance system database who had been treated and stabilized with their antihypertensive therapy and not exposed to any NSAID between 1 April 2005 and 1 April 2006. The maximum follow-up duration was 4 years.

Results

Adjusted hazard ratios (HR) for hypertension treatment intensification were 1.34 [95 % confidence interval (CI) 1.05–1.71] for NSAIDs in general, 1.79 (95 % CI 1.15–2.78) for diclofenac and 2.02 (95 % CI:1.09–3.77) for piroxicam. There were significant interactions between NSAIDs and angiotensin converting enzyme inhibitors (ACEIs; HR  4.09, 95 % CI 2.02–8.27) or angiotensin receptor blockers (ARBs; HR 3.62, 95 % CI 1.80–7.31), but not with other antihypertensive drugs.

Conclusions

Exposure to NSAIDs leads to an intensification of hypertension treatment, especially in patients treated with ACEIs or ARBs. Renin–angiotensin system blockers should be avoided whenever NSAIDs are prescribed.

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Acknowledgments

Jean-Pascal Fournier was a beneficiary of the “Année-Recherche” funding of the French Ministry of Research and Education (Faculty of Medicine, University of Toulouse, France). The authors thank Carole Suarez of the Health Insurance System of Midi-Pyrénées for her kind help during the data extraction, and Jane Phillips and Julie Dupouy for corrections of the manuscript.

Competing interests

None.

Author information

Authors and Affiliations

  1. Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France

    Jean-Pascal Fournier, Agnès Sommet, Atul Pathak, Maryse Lapeyre-Mestre & Jean-Louis Montastruc

  2. INSERM, UMR1027, Toulouse, France

    Jean-Pascal Fournier, Agnès Sommet, Maryse Lapeyre-Mestre & Jean-Louis Montastruc

  3. Département Universitaire de Médecine Générale, Faculté de Médecine, Université Paul Sabatier, Toulouse, France

    Jean-Pascal Fournier & Stéphane Oustric

  4. Service de Pharmacologie Clinique, Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d’Information sur le Médicament, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

    Agnès Sommet, Atul Pathak, Maryse Lapeyre-Mestre & Jean-Louis Montastruc

  5. Direction Régionale du Service Médical Midi-Pyrénées (CNAMTS), Toulouse, France

    Robert Bourrel

  6. INSERM UMR1048, Toulouse, France

    Atul Pathak

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  1. Jean-Pascal Fournier
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Correspondence to Jean-Pascal Fournier.

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Fournier, JP., Sommet, A., Bourrel, R. et al. Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study. Eur J Clin Pharmacol 68, 1533–1540 (2012). https://doi.org/10.1007/s00228-012-1283-9

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  • DOI: https://doi.org/10.1007/s00228-012-1283-9

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