THE EFFECTS OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS ON BLOOD PRESSURESOF PATIENTS WITH HYPERTENSION CONTROLLED BY VERAPAMIL

Background: Nonsteroidal anti-inflammatory drugs may attenuate the ant ihypertensive effects of diuretics, beta-blockers, angiotensin-convert ing enzyme inhibitors, central alpha-agonists, and other vasodilators. Their effects on the antihypertensive efficacy of calcium channel blo ckers are inadequately studied in small numbers of patients but appear to be minimal. Methods: A three-phase, randomized, double-blind, plac ebo-controlled multicenter study included 162 patients aged 18 to 75 y ears with essential hypertension. After diastolic blood pressure was c ontrolled to 90 mm Hg or less with once-daily verapamil hydrochloride, patients received ibuprofen, naproxen, or placebo matching capsules f or 3 weeks, and blood pressure, heart rate, weight, and adverse effect s were evaluated. A general linear model with 95% confidence intervals was used to compare each nonsteroidal anti-inflammatory drug treatmen t group with the placebo group. Results: No significant differences in sitting, standing, or supine blood pressure were noted with naproxen or ibuprofen compared with placebo. The percentages of patients in eac h treatment group with increases of 10 mm Hg or more in either systoli c or diastolic blood pressure were similar. Statistically significant increases in weight were seen with both nonsteroidal anti-inflammatory drug therapies. Changes in pulse rate were not significant. The incid ence of adverse effects was similar across all three treatment groups. Conclusions: The addition of naproxen or ibuprofen to the treatment o f hypertensive patients in whom blood pressure is controlled by once-d aily verapamil does not cause an increase in blood pressure. Verapamil may therefore offer considerable advantages in maintaining control of blood pressure in patients who regularly receive nonsteroidal anti-in flammatory drug therapy.