Drugs & Adverse Effects / Complications Due to NSAIDS

submitted by Dr. Gary Farr Last Updated February, 12, 2002

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Touted as being "more safe" than aspirin, a class of drugs called non-steroidal anti-infalmmatory drugs are the biggest sellers on the market. But are they really "safe"? Read on and draw your own conclusions.

Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an underrecognized public health problem.
Page J, Henry D.
Arch Intern Med 2000 Mar 27;160(6):777-84.

The results of this study indicate that nonsteroidal anti-inflammatory drugs (NSAIDs) are an important cause of hospitalization for congestive heart failure (CHF) in individuals with or without a history of heart disease. The study was conducted on 365 patients hospitalized for heart failure and 658 controls. Individuals who used NSAIDs in the previous week had a 2-fold increased risk of hospitalization for CHF, compared to non-users. In patients with a history of heart disease, use of NSAIDs was associated with a 10-fold increased risk of hospitalization for CHF. The risk increased with increasing doses of NSAIDs taken in the previous week, and was greater with NSAIDs of long versus short half-life. The authors concluded that NSAIDs could account for approximately 20% of hospitalizations for congestive heart failure. Heart failure affects approximately 4.6 million Americans and this condition represent the most common hospital discharge diagnosis among patients older than 65 years. If this association is casual, as the dose-response relation suggests, cardiovascular morbidity due to NSAIDs would surpass gastro-intestinal NSAID-related morbidity, which alone is responsible for a minimum of 105,000 hospitalizations and 16,500 deaths occurring each year in the U.S. The economic and health consequences of these findings are staggering.

NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics.

Heerdink ER, Leufkens HG, Herings RM, Ottervanger JP, Stricker BH, Bakker A.
Arch Intern Med 1998 May 25;158(10):1108-12.

The results of this study, conducted on a sample population of 10,519 individuals older than 55 years taking diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs), show that users of both drugs have a twofold increased risk of being hospitalized for congestive heart failure, compared to users of diuretics only.

Congestive heart failure due to nonsteroidal anti-inflammatory drugs in the elderly.

Van den Ouweland FA, Gribnau FW, Meyboom RH.
Age Ageing 1988 Jan;17(1):8-16.

This study indicates that the occurrence of congestive heart failure in elderly individuals with or without a history of cardiovascular disease who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) is a probable treatment-related complication. Multiple factors can be involved in the etiology of this complication, including toxicity from relative overdose, alteration of cardiovascular homeostasis, and interference with anti-hypertensive treatment.

Nonsteroidal anti-inflammatory drugs and blood pressure in an elderly population.

Chrischilles EA, Wallace RB.
J Gerontol 1993 May;48(3):M91-6.

This study shows that nonsteroidal anti-inflammatory drugs (NSAIDs) raise systolic blood pressure in elderly individuals by approximately 5 mm Hg and may antagonize the effects of antihypertensive medications. Users of NSAIDs are also twice as likely to have systolic blood pressure higher than 140 mm Hg, compared to nonusers. The authors conclude that NSAIDs may be an important reason for therapeutic failure in the treatment of hypertension.

Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis.

Johnson AG, Nguyen TV, Day RO.
Ann Intern Med 1994 Aug 15;121(4):289-300.

This study evaluated data from 38 randomized, placebo-controlled trials, to determine the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure. The results of the analysis revealed that use of NSAIDs is associated with an increase in blood pressure levels by an average of 5.0 mm Hg, and with the neutralization of the effects of antihypertensive treatment, particularly in individuals treated with beta-blockers.

Antagonism of antihypertensive drug therapy by nonsteroidal anti-inflammatory drugs.
Oates JA.
Hypertension 1988 Mar;11(3 Pt 2):II4-6.

This article discloses the property that certain nonsteroidal anti-inflammatory drugs (NSAIDs) have to antagonize the blood pressure lowering effects of antihypertensive treatment. Indomethacin abolishes the effects of several antihypertensive drugs, while piroxicam raises blood pressure in treated patients. The magnitude of this effect varies from patient to patient, from undetectable to dangerous increases in blood pressure.

Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy.

Gurwitz JH, Avorn J, Bohn RL, Glynn RJ, Monane M, Mogun H.
JAMA 1994 Sep 14;272(10):781-6.

This case-control study, conducted on over 9,400 patients aged 65 or older with newly diagnosed hypertension, shows that users of NSAIDs have a 66% increased risk of starting antihypertensive treatment, compared to nonusers. The risk increases with increasing doses of NSAIDs. The adverse effects on blood pressure levels can have a major impact on public health, particularly since approximately 20 millions Americans are currently taking both class of drugs.

The impact of nonsteroidal anti-inflammatory drugs on hypertension: alternative analgesics for patients at risk.

Ruoff GE.
Clin Ther 1998 May-Jun;20(3):376-87; discussion 375.

This article highlights that in the U.S., approximately 20 million individuals and 12% of those aged 60 years and older, use concurrently both nonsteroidal anti-inflammatory drugs (NSAIDs) and antihypertensive drugs. Since NSAIDs limit the efficacy of antihypertensive therapy, their use, unless deemed really necessary, should be avoided, and substituted with other class of analgesics.