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Ibuprofen Interferes with the Efficacy of Antihypertensive Drugs: A Randomized, Double-Blind, Placebo-Controlled Trial of Ibuprofen Compared with Acetaminophen
Abstract
Study Objective: To assess the effects of Ibuprofen on blood pressure control in patients being treated with antihypertensive drugs. Design: Randomized, blinded, placebo-controlled, parallel trial of Ibuprofen compared with acetaminophen and with placebo in 3-week treatment periods. Setting: A general internal medicine clinic at a university hospital. Patients: Forty-five patients with essential hypertension controlled by treatment with at least two antihypertensive drugs were enrolled. Of these, 41 completed the study; treatment was discontinued in 3 of the 15 patients in the Ibuprofen group due to breakage of the drug capsules, and after randomization in 1 of the 14 patients in the placebo group due to unstable angina. All 15 patients in the acetaminophen group completed the study. Interventions: All previous antihypertensive regimens were continued. During the 3-week treatment, Ibuprofen, 400 mg, was administered orally every 8 hours; acetaminophen, 1 g, orally every 8 hours; or placebo, 2 capsules, orally every 8 hours. Measurements and Main Results: In the Ibuprofen group, the mean increase from baseline after 3 weeks of treatment was significant in the average supine diastolic blood pressure (6.4 mm Hg; 95% confidence interval [Cl], 1.05 to 11.75; p = 0.0239); supine mean arterial pressure (6.6 mm Hg; 95% Cl, 1.25 to 11.95; & p = 0.0205); and sitting mean arterial pressure (5.8 mm Hg; 95% Cl, 1.57 to 10.04; p = 0.0123). The mean increase in blood pressure variables in the Ibuprofen group was significantly different compared with the mean increase in the variables in the placebo group after 3 weeks of treatment: supine systolic blood pressure (7.1 mm Hg compared with -4.5 mm Hg; 95% Cl for the difference in means, 2.5 to 20.6; p = 0.0133); supine diastolic pressure (6.4 mm Hg compared with 0.0; 95% Cl for difference in means, 0.87 to 12.4; p = 0.0250); supine mean arterial pressure (6.6 mm Hg compared with -1.5; 95% Cl for difference in means, 2.0 to 14.2; p= 0.0110); sitting systolic pressure (6.8 mm Hg compared with -3.7; 95% Cl for difference in means, 2.0 to 19.0; p = 0.0169); sitting diastolic pressure (5.3 mm Hg compared with -1.1; 95% Cl for difference in means, 0.76 to 12.1; p = 0.0273); and sitting mean arterial pressure (5.8 mm Hg compared with -2.0; 95% Cl for difference in means, 1.5 to 14.1; p = 0.0169). When compared with the acetaminophen group after 3 weeks of treatment, the Ibuprofen group also showed statistically significant changes in supine diastolic and mean arterial pressures, and sitting diastolic and mean arterial pressures. Conclusions: Ibuprofen can interfere with blood pressure control in certain patients with treated mild-to-moderate hypertension. Further clinical studies are needed to document these findings and determine which patients are most likely to have an ibuprofen-related impairment in blood pressure control.
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“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 [184]
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Resistant Hypertension: Diagnosis, Evaluation, and Treatment
Calhoun, D. A., Jones, D. W., Textor, S. C., Goff, D. C., Murphy, T. P., Toto, R. D., White, A. J., Cushman, W. C., White, W. B., Sica, D. A., et al. (2008) · Circulation · doi:10.1161/circulationaha.108.189141 · Cited by 2,240
Resistant Hypertension: Diagnosis, Evaluation, and Treatment
Calhoun, D. A., Jones, D. W., Textor, S. C., Goff, D. C., Murphy, T. P., Toto, R. D., White, A. J., Cushman, W. C., White, W. B., Sica, D. A., et al. (2008) · Hypertension · doi:10.1161/hypertensionaha.108.189141 · Cited by 1,416
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Graham, G. G., Davies, M. J., Day, R. O., Mohamudally, A., & Scott, K. F. (2013) · Inflammopharmacology · doi:10.1007/s10787-013-0172-x · Cited by 671
Ibuprofen: pharmacology, efficacy and safety
Rainsford, K. D. (2009) · Inflammopharmacology · doi:10.1007/s10787-009-0016-x · Cited by 699
Metadata
- Authors
- RADACK, K. L., DECK, C. C., & BLOOMFIELD, S. S.
- Affiliations
- University of Cincinnati (US)
- Cincinnati, Ohio
- Corresponding author
- RADACK, KENNETH L
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1987-11-01
- Volume
- 107
- Issue
- 5
- Pages
- 628-635
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W1973757442
- Cited by
- 140
- References
- 27
- Citations by year
- 2024: 2 · 2023: 2 · 2022: 3 · 2021: 1 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 1 · 2015: 8 · 2014: 3 · 2013: 5 · 2012: 8
- FWCI
- 7.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (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 (medical) › Inflammatory mediators and NSAID effects
- Keywords
- ibuprofen, antihypertensive drugs, essential hypertension, drug interactions, blood pressure control, paracetamol, nonsteroidal anti-inflammatory drugs, diastolic blood pressure, mean arterial pressure, combination therapy, adverse drug reactions, drug discontinuation, angina pectoris
- MeSH terms
- Acetaminophen, Adrenergic beta-Antagonists, Adult, Aged, Antihypertensive Agents, Blood Pressure, Clinical Trials as Topic, Double-Blind Method, Female, Humans, Hypertension, Ibuprofen, Male, Middle Aged, Random Allocation, Renin
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