Hypertensive Crisis: The Causative Effects of Nonsteroidal Anti- Inflammatory Drugs

Abstract

Abstract62 year-old female presents with hypertensive urgency while taking daily NSAIDs. This case demonstrates the effect of NSAIDs on BP, an often over-looked etiology of secondary hypertension. The detrimental effects of NSAIDs upon blood pressure have been well documented. The report reiterates and reviews the severity of the problem. We will review the existing literature and discuss the importance of small increases in blood pressure. Keywords: Hypertension; NSAID-induced hypertension; Chronic pain Case Report A High Pressure SituationA 62 year-old white female with no documented past medical history of hypertension or any other chronic disease state presented to the Emergency Department with severe occipital headache and was found to have hypertensive urgency, with initial blood pressure (BP) of 225/110 mmHg. She had started taking OTC ibuprofen 3200-4000 mg daily for three weeks due to cervical-spine radicular pain. Her clinical course is outlined in detail in Table 1. Physical exam revealed flushing and mild non-pitting edema of the digits. Ophthalmologic and cardiac exams were normal as was the electrocardiogram (ECG). Initial work-up revealed a normal renal function with 2+ proteinuria on urinalysis, mild hypokalemia that resolved spontaneously, and a CT head that was negative for hemorrhage. She initially received 0.2 mg of clonidine and the ibuprofen was discontinued. When she saw her primary care physician the following day, BP was 170/100 mmHg; she was started on 100/25 mg of losartan/HCT, an angiotensin-receptor blocker/thiazide combination and 5 mg of amlodipine, a calcium channel blocker, for Stage II hypertension. The patient was then seen by a hypertension specialist; 5 mg nebivolol, a β1 cardioselective vasodilating β-blocker, was added and home BP measurements were initiated. Home BP documented that BPs soon decreased to <120/80 mmHg, after which amlodipine and losartan/HCT were tapered off and nebivolol alone continued. The patient was noted to have a white-coat hypertension pattern, but on continued follow up has done very well as again indicated in Table 1. It does appear that she had pre-existing hypertension prior to her acute episode. Discussion NSAID-induced hypertensionNonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently used medications in the USA; more than 29 million adults are reported to be regular users of NSAIDs [1]. Often thought of as benign medications, NSAIDs have been shown to have a number of serious side effects including hypertension, renal failure, gastrointestinal bleeding, bronchospasm, and severe cardiovascular complications such as myocardial infarction, stroke, and congestive heart failure. This case demonstrates the effect of NSAIDs on BP, an often over-looked etiology of secondary hypertension. We will review the existing literature and discuss the importance of small increases in blood pressure. The mechanism of action of NSAIDs involves blocking the conversion of arachidonic acid to the inflammatory prostaglandins (PG) and thromboxane ...

Effect of Indomethacin on Blood Pressure Managed by Captopril and Losartan in Hypertensive Patients

“…Various studies results show that NSAID medications had a positive effect on hypertensive patients. [9][10] Commonly it shows minor effects but is properly visible with β-blockers vasodilators. This shows that mechanism of action of the antihypertensive agent is the non-specific or actual mechanism of NSAIDs to regulate BP is poorly understood.…”