Long-term NSAID use by hypertensive patients with CAD increases risk of adverse events

A study published in the July issue of The American Journal of Medicine, reports that among hypertensive patients with coronary artery disease, chronic self-reported use of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with an increased risk of adverse events during long-term follow-up. Long-term NSAIDs use is common for treatment of chronic pain.

Researchers from the Division of Cardiovascular Medicine, College of Medicine and the Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, found that after a mean of 2.7 years of follow-up, in hypertensive patients with (average age of 65 years), chronic self-reported NSAID use was associated with a 47% increase in the occurrence of death, nonfatal , or nonfatal stroke. This was due to a 90% increase in all-cause mortality (which persisted into extended follow-up of more than 5 years), a 126% increase in , and a 66% increase in total myocardial infarctions. There was no significant difference in the occurrence of stroke.

"Among coronary artery disease patients with hypertension, chronic self-reported use of NSAIDs was associated with harmful outcomes, and this practice should be avoided where possible," commented Anthony A. Bavry, MD, MPH, Assistant Professor, Division of Cardiovascular Medicine, College of Medicine at the University of Florida, Gainesville. "This association did not appear to be due to elevated blood pressure because chronic NSAID users actually had slightly lower on-treatment blood pressure over a mean of 2.7 years of follow-up. Until further data are available, alternative modes of pain relief should be considered for these patients."

Currently, there is a paucity of data about possible harmful effects of chronic NSAIDs in patients with hypertension and coronary artery disease. This observational study was conducted within a large randomized trial that provided long-term blood pressure measures, target blood pressures, and standardized assessment of adverse cardiovascular outcomes.

Data were obtained from INVEST (The INternational VErapamil Trandolapril Study), a conducted in 14 countries, originally designed to compared the effects of a calcium antagonist (verapamil SR)-based strategy with a beta-blocker (atenolol)-based strategy for hypertension among patients with stable coronary artery disease. In this study, there were 882 chronic NSAID users and 21,694 nonchronic NSAID users. Many of the previous analyses on this topic have been conducted from case-control studies.

Interestingly investigators did not find a difference in serious gastrointestinal bleeding events from chronic NSAID use, as might have been expected. While this was somewhat counterintuitive, chronic NSAID users likely started these medications before study enrollment, at which time major bleeding events could have occurred.

More information: The article is "Harmful Effects of NSAIDs among Patients with Hypertension and Coronary Artery Disease" by Anthony A. Bavry, MD, MPH, Asma Khaliq, MD, Yan Gong, PhD, Eileen M. Handberg, PhD, Rhonda M. Cooper-DeHoff, PharmD, MS, and Carl J. Pepine, MD. It appears in The American Journal of Medicine, Volume 124, Issue 7 (July 2011)

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Recorded Ebola deaths top 7,000

11 hours ago

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

16 hours ago

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

Dec 19, 2014

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

Dec 19, 2014

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.