THE IMPACT OF IBUPROFEN ON THE EFFICACY OF ANTIHYPERTENSIVE TREATMENTWITH HYDROCHLOROTHIAZIDE IN ELDERLY PERSONS

Background. Nonsteroidal antiinflammatory drugs (NSAIDs) may alter blo od pressure through their inhibitory effects on prostaglandin biosynth esis. Such potential hypertensive effects of NSAIDs have not been adeq uately examined in the elderly, who are the largest group of NSAID use rs. Methods. We performed a randomized, double-blind, two-period cross over trial of ibuprofen (1800 mg per day) vs placebo treatment in pati ents older than 60 years of age with hypertension controlled with hydr ochlorothiazide. While continuing their usual thiazide dosage, subject s were randomized to a 4-week treatment period (ibuprofen or placebo) followed by a 2-week placebo wash-out period and a second 4-week treat ment period with the alternative therapy. Supine and standing systolic and diastolic blood pressures were measured weekly. Results. Of 25 ra ndomized subjects, 22 completed the study protocol (mean age = 73 +/- 6.7 years). Supine systolic blood pressure and standing systolic blood pressure were increased significantly with ibuprofen treatment, compa red with placebo. Mean supine systolic blood pressures were 143.8 +/- 21.0 and 139.6 +/- 15.9 mmHg on ibuprofen and placebo, respectively (p = .004). Mean standing systolic blood pressures were 148.1 +/- 19.9 a nd 143.4 +/- 17.9 mmHg on ibuprofen and placebo, respectively (p = .00 2). Conclusion. We conclude that 1800 mg per day of ibuprofen does ind uce a significant increase in systolic blood pressure in older hyperte nsive patients treated with hydrochlorothiazide. NSAID therapy may neg atively impact the control of hypertension in elderly patients.