Effect of indomethacin on blood pressure in elderly people with essential hypertension well controlled on amlodipine or enalapril
Abstract
Arthritis and hypertension are frequent comorbidities in the elderly hypertensive population. Nonsteroidal anti-inflammatory drugs are often used to relieve pain in arthritic patients but a side effect is sodium retention and consequent elevation of blood pressure (BP). The effect of dihydropyridine calcium blocking drugs is relatively independent of sodium intake, whereas the angiotensin-converting enzyme (ACE) inhibitors' effects can be blunted by a high-sodium diet. This study compared the effects of indomethacin with placebo in elderly patients with essential hypertension who had been controlled with amlodipine or enalapril. Indomethacin 50 mg twice daily or placebo was administered for 3 weeks in a double-blind crossover study to patients controlled with amlodipine or enalapril. The response was assessed by ambulatory BP measurement. Indomethacin raised BP and lowered pulse rates in patients taking enalapril but had little effect in patients receiving amlodipine. The difference caused by indomethacin between the two groups was 10.1/4.9 mm Hg increase in BP and a 5.6 beats/min fall in pulse in people taking enalapril. Addition of indomethacin to patients taking either drug caused a rise in weight and a fall in plasma renin. It is postulated that the effect is due to inhibition of prostaglandin synthesis, which causes sodium retention. In patients taking amlodipine, the fall in plasma renin ameliorates the effect of sodium retention on BP. In patients taking enalapril, plasma renin falls but this is not translated into an effect because of the blockage of converting enzyme. Thus, the full effect of sodium retention on BP is expressed. In patients treated with indomethacin, fewer patients may respond to ACE inhibitors. However, the major problem is the patient who intermittently takes indomethacin or other nonsteroidal anti-inflammatory drugs, which, if a person is treated by an ACE inhibitor causes BP to go out of control. In such patients amlodipine would appear to be a preferred choice to enalapril.
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The systolic blood pressure increase with NSAIDs in ACE inhibitor users ranged from 5 to 10 mm Hg.
“The SBP increase with NSAIDs in ACE inhibitor users ranged from 5 to 10 mm Hg.196–199”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [197]
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- Authors
- Morgan, T. O., Anderson, A., & Bertram, D.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Morgan, T. O.
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2000-11-01
- Volume
- 13
- Issue
- 11
- Pages
- 1161-1167
- ISSN
- 0895-7061 (ISSN-L)
- 1941-7225
- OpenAlex
- W2082572643
- Cited by
- 102
- References
- 18
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2019: 1 · 2018: 8 · 2017: 3 · 2016: 2 · 2014: 2 · 2013: 4 · 2012: 4
- FWCI
- 4.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Eicosanoids and Hypertension Pharmacology
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Keywords
- indomethacin, essential hypertension, elderly patients, amlodipine, enalapril, nonsteroidal anti-inflammatory drugs, sodium retention, blood pressure, plasma renin, prostaglandin synthesis, calcium channel blockers, ACE inhibitors, ambulatory blood pressure, pulse rate, weight gain
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Blood Pressure, Body Weight, Double-Blind Method, Drug Interactions, Dyspepsia, Enalapril, Female, Humans, Hypertension, Indomethacin, Male, Middle Aged, Nausea, Pain, Renin, Abdominal Pain, Amlodipine
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