Influence of non-steroidal anti-inflammatory drugs on renal function and 24 h ambulatory blood pressure-reducing effects of enalapril and nifedipine gastrointestinal therapeutic system in hypertensive patients
Abstract
OBJECTIVE: To evaluate the influence of non-steroidal anti-inflammatory drugs (NSAIDs; aspirin and indomethacin) on the renal and antihypertensive effects of enalapril and nifedipine gastrointestinal therapeutic system (GITS) in patients with essential hypertension. DESIGN AND METHODS: In a crossover study, 18 patients on an unrestricted-salt diet were randomly assigned to receive either enalapril (20-40 mg/day) or nifedipine-GITS (30-60 mg/day) for 4-8 weeks, followed by aspirin (100 mg/day for 2 weeks) and then indomethacin (75 mg/day for 1 week). Blood pressure was measured by 24h ambulatory monitoring. RESULTS: Enalapril and nifedipine-GITS significantly reduced blood pressure compared with placebo. Aspirin did not alter the antihypertensive effect of either drug. Indomethacin attenuated (by 45%) the antihypertensive effect of enalapril throughout the 24h period of evaluation, but did not interfere with the effect of nifedipine. Furthermore, indomethacin significantly reduced the fractional excretion of sodium and plasma levels of prostaglandins in a similar way when added to either the enalapril or the nifedipine regimen. CONCLUSIONS: Vasodilatory prostaglandins are probably involved in the antihypertensive effects of enalapril but not of nifedipine, and this interaction seems to be independent of any indomethacin-induced decrease in renal sodium excretion. Nifedipine may be an appropriate drug to treat hypertensive patients requiring concomitant therapy with NSAID.
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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 [196]
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- Authors
- Pol??nia, J., Boaventura, I., Gama, G., Cam??es, I., Bernardo, F., Andrade, P., Nunes, J. P., Brand??o, F., & Cerqueira-Gomes, M.
- Affiliations
- Hospital de São João (PT)
- Venue
- Journal of Hypertension
- Published
- 1995-08
- Volume
- 13
- Issue
- 8
- Pages
- 925-931
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W1982621997
- Cited by
- 63
- References
- 0
- Citations by year
- 2025: 1 · 2024: 5 · 2022: 2 · 2020: 1 · 2018: 4 · 2017: 4 · 2016: 1 · 2015: 1 · 2014: 2 · 2012: 3
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- 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 › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- nonsteroidal anti-inflammatory drugs, indomethacin, aspirin, enalapril, essential hypertension, antihypertensive drug interactions, renal function, fractional excretion of sodium, prostaglandins, ambulatory blood pressure
- MeSH terms
- Anti-Inflammatory Agents, Non-Steroidal, Blood Pressure, Drug Interactions, Enalapril, Female, Humans, Hypertension, Kidney, Male, Middle Aged, Nifedipine, Cross-Over Studies, Blood Pressure Monitoring, Ambulatory
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