Fosinopril, HCTZ, and NSAIDS
November 15, 1999
Fosinopril, HCTZ, and NSAIDS
Nsaids can induce elevations of blood pressure by blocking the vasodilatory and natriuretic actions of prostaglandins. Effect on normotensive individuals is usually small, and interference with the antihypertensive agents varies with the class of agent used. For instance, the effects of calcium channel blockers, whose antihypertensive action appears to be prostaglandin-independent, are not diminished by NSAIDs. ACE inhibitors and diuretics appear to be the agents most influenced by NSAIDs.
There is some variance, even among NSAIDs, for potential to induce hypertension or blockade of antihypertensive medication, with indomethacin commonly cited as most likely to promote elevations of blood pressure. The purpose of this study was to examine the effect of analgesic medication (sulindac, ibuprofen, or nabumetone) on blood pressure in hypertensive osteoarthritis patients who were already treated with the combination of an ACE inhibitor (fosinopril) and a diuretic (HCTZ). Though studies have previously examined the effect of NSAIDs on either class of antihypertensive agent alone, there is scanty information on NSAIDs’ effect on combination therapies.
In this study group composed of black women (n = 17), there was no effect of NSAIDs on blood pressure control. Thakur and associates caution that their observations may or may not extend to other populations (e.g., whites of both genders and black men). Nonetheless, it is encouraging to see demonstrated in this trial that fosinopril combined with HCTZ may not suffer diminished efficacy when typical NSAID dosing strategies are used.
Thakur V, et al. Am J Hypertens 1999; 12:925-928.
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