Arthritis

Ibuprofen Increases Blood Pressure in Arthritis Patients

The non-selective non-steroidal anti-inflammatory drug (NSAID) ibuprofen is associated with significantly higher systolic blood pressure (SBP) and a greater risk of new-onset hypertension among patients with osteoarthritis (OA) or rheumatoid arthritis (RA) with evidence of or increased risk for coronary artery disease, compared with the use of the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib, according to a recent study.

Findings were presented by Dr Frank Ruschitzka on August 28, 2017, at the European Society of Cardiology Congress in Barcelona, Spain.1
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NSAIDs and COX-2 inhibitors are widely prescribed for pain worldwide. However, both NSAIDs and COX-2 inhibitors are known to be associated with increased BP and adverse cardiovascular events.

To compare the effects of celecoxib, ibuprofen, and naproxen on BP, Ruschitzka and colleagues assessed 444 patients with OA or RA who had evidence of or increased risk for coronary artery disease. Patients were a mean age of 62 years, and 54% of patients were women.

During the trial, patients received 100 to 200 mg celecoxib twice daily, 600 to 800 mg ibuprofen three times daily, or 375 to 500 mg naproxen twice daily, and were matched with a control group receiving placebos. The effects of each drug on 24-hour ambulatory BP after 4 months were assessed.

Results indicated that the change in mean 24-hour SBP was -0.3 mmHg in patients on celecoxib, 3.7 mmHg in patients on ibuprofen, and 1.6 mmHg in patients on naproxen. Additionally, 23.2% of patients on ibuprofen with normal BP at baseline had developed hypertension, compared with 19.0% on naproxen and 10.3% on celecoxib.

“In PRECISION-ABPM, allocation to the non-selective NSAID ibuprofen, compared with the COX-2 selective inhibitor celecoxib was associated with a significant increase of SBP, and a higher incidence of new-onset hypertension,” the researchers concluded.2

—Christina Vogt

References:

  1. Ibuprofen associated with blood pressure rise in arthritis patients at cardiovascular risk (PRECISION-ABPM) [press release]. Barcelona, Spain: European Society of Cardiology; August 28, 2017. https://www.escardio.org/The-ESC/Press-Office/Press-releases/ibuprofen-associated-with-blood-pressure-rise-in-arthritis-patients-at-cardiovascular-risk. Accessed August 28, 2017.
  2. Ruschitzka F, Borer JS, Krum H, et al. Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) trial [Published online August 28, 2017]. Eur Heart J. doi:10.1093/eurheartj/ehx508.