Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients
Abstract
Abstract —NSAIDs are known to attenuate the effects of some antihypertensive medications. It is not known whether the new class of angiotensin II receptor antagonists is similarly affected. We conducted a multicenter study assessing the effect of indomethacin on the antihypertensive effects of losartan and captopril. After 4 weeks of placebo washout, hypertensive patients received 6 weeks of active antihypertensive therapy with either 50 mg losartan once daily (n=111) or 25 mg captopril twice daily for 1 week, which was increased to 50 mg twice daily for 5 weeks (n=105). This was followed by 1 week of concomitant therapy with indomethacin (75 mg daily). The primary outcome measure was the change in mean 24-hour ambulatory diastolic blood pressure after the addition of indomethacin. Both captopril and losartan significantly lowered ambulatory diastolic blood pressure (losartan −5.3 mm Hg, P <0.001; captopril −5.6 mm Hg, P <0.001) after 6 weeks of therapy. Indomethacin significantly attenuated the 24-hour ambulatory diastolic blood pressure for both losartan (2.2 mm Hg, P <0.05) and captopril (2.7 mm Hg, P <0.001) and also attenuated the effect of captopril on trough sitting diastolic blood pressure. Changes in daytime diastolic blood pressure (7:00 am to 11:00 pm ) were similar to the 24-hour response in both groups. Nighttime diastolic blood pressure (11:01 pm to 6:59 am ) was significantly attenuated in captopril-treated patients (2.0 mm Hg, P <0.05), but losartan was unaffected (0.4 mm Hg). Thus, concurrent treatment with indomethacin similarly attenuates the 24-hour antihypertensive response to losartan and captopril.
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NSAIDs affect the treatment effect of several antihypertensive medication classes, including diuretics, ACE inhibitors, ARBs, and β-blockers.
“Furthermore, NSAIDs affect the treatment effect of several antihypertensive medication classes, including diuretics, ACE inhibitors, ARBs, and β-blockers.184,185”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [185]
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Papel de los inhibidores selectivos de la COX-2 en la hipertensión arterial
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Resistant Hypertension: Etiology, Evaluation and Management
Olafiranye, O., Mahmud, S., Zizi, F., McFarlane, S. I., Jean‐Louis, G., & Ogedegbe, G. G. (2012) · Humana Press eBooks · doi:10.1007/978-1-60327-357-2_6
NSAIDs and Cardiovascular Toxicity
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Giles, T. D., Falkner, B. E., White, A. J., Cushman, W. C., White, W. B., Sica, D. A., Ferdinand, K. C., Calhoun, D. A., Jones, D. W., Textor, S. C., et al. (2013)
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BLOOD PRESSURE INCREASES INDUCED BY IATROGENESIS, OVER THE COUNTER SUBSTANCES, AND HERBALS PRODUCTS
Wang, S., & Sander, G. E. (2021) · Medical Research Archives · doi:10.18103/mra.v9i5.2394
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NSAIDs and Cardiovascular Toxicity
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- Authors
- Conlin, P. R., Moore, T. J., Swartz, S. L., Barr, E., Gazdick, L., Fletcher, C., DeLucca, P., & Demopoulos, L.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Hypertension
- Published
- 2000-09
- Volume
- 36
- Issue
- 3
- Pages
- 461-465
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W1995194227
- Cited by
- 88
- References
- 21
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 7 · 2016: 2 · 2015: 5 · 2014: 3 · 2013: 7 · 2012: 6
- FWCI
- 3.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Eicosanoids and Hypertension Pharmacology
- Keywords
- indomethacin, captopril, losartan, antihypertensive drug interactions, nonsteroidal anti-inflammatory drugs, angiotensin receptor blockers, ACE inhibitors, ambulatory blood pressure, diastolic blood pressure, nocturnal blood pressure
- MeSH terms
- Anti-Inflammatory Agents, Non-Steroidal, Antihypertensive Agents, Blood Pressure, Captopril, Cardiovascular Agents, Circadian Rhythm, Drug Interactions, Female, Humans, Indomethacin, Male, Middle Aged, Losartan
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