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Ibuprofen Ups Systolic BP, New-Onset Hypertension Risk

For patients with arthritis and increased CV risk, prescription-strength ibuprofen has a worse effect on blood pressure than naproxen or modest-dose celecoxib, PRECISION-ABPM results suggest.

The results, reported here at the European Society of Cardiology 2017 Congress and online in the European Heart Journal, are based on some 60,000 automated blood pressure readings in 444 arthritis patients (92% osteoarthritis) with established CVD or at increased CV risk who required nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 6 months.

The primary outcome was change from baseline in 24-hour mean systolic blood pressure after 4 months of treatment.

It increased 3.7 mm Hg with ibuprofen and 1.6 mm Hg with naproxen and declined 0.3 mm Hg with the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib. Only the difference between ibuprofen and celecoxib was significant (P=0.009).

Even a 3-mm-Hg difference in blood pressure multiplied by the 100,000 beats human hearts take each day equates to an extra 300 to 400 m of mercury per day or 100 km per year that the heart would have to pump against a higher pressure.

In patients with [heart failure with preserved ejection fraction] HFpEF, an elderly lady with arthritis, that tips the balance toward decompensation, that matters.

Compared with placebo, all NSAIDs likely raise blood pressure, especially in patients prone to hypertension, those with chronic kidney disease, and the elderly—this is exactly the type of patients who require NSAIDs for arthritis. Whichever NSAID is chosen, clinicians should be aware of this effect and should be treating hypertension according to guidelines.

Ruschitzka F, Borer JS, Krum H, et al. Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective randomized evaluation of celecoxib integrated safety versus ibuprofen or naproxen ambulatory blood pressure measurement) trial. Eur Heart J 2017; DOI:10.1093/eurheart/ehx508. Article