Abstract 2586: Chronic Use of Ibuprofen Increases Systolic and Diastolic Blood Pressure and Incidence of Hypertension Adverse Events: a Systematic Review of the Literature
Objective: To review and summarize the published clinical trial evidence for the effects of chronic use of non-selective NSAIDs on blood pressure (BP) and hypertension.
Methods: Systematic review of English publications, using MedLine, of randomized clinical trials of oral non-selective NSAIDs of >=4 weeks duration, published in the English peer-reviewed literature, that reported systolic (SBP) and/or diastolic BP (DBP) data at the end of the study. Trials in which BP was treated by titration of antihypertensive drugs or introduction of a diet, and those in which BP was measured by 24-hour monitoring were excluded. Outcome measures included change in SBP and DBP from baseline to study end and the incidence of reported hypertension adverse events (AEs), such as new onset or aggravation of existing hypertension. Data were analyzed by meta-analytic techniques with tests for heterogeneity across studies.
Results: Thirty-one articles met inclusion criteria. Most patients in the trials had hypertension and/or osteoarthritis. Twenty studies reported SBP and/or DBP change from baseline to study end, or group mean data at baseline and study end, allowing calculation of change from baseline. Eleven studies reported hypertension AE rates. Mean changes in SBP and DBP by drug are shown in the table⇓. Ibuprofen significantly increased both SBP and DBP; indomethacin significantly increased DBP only. For incidence of hypertension adverse events the RR (95% CI) vs. placebo was: ibuprofen 2.85 (1.44, 5.65), nabumetone 1.49 (0.49, 4.52), naproxen 1.75 (0.74, 4.13).
Conclusions: Published randomized clinical trial evidence shows chronic use of ibuprofen (>=4 weeks )increases SBP about 3.5 mmHg and DBP about 1 mmHg and is associated with a significant increase in the incidence of reported hypertension AEs vs. placebo. Although the data are limited, these effects do not appear to apply to chronic use of other non-selective NSAIDs with the possible exception of indomethacin.