INITIATION OF ANTIHYPERTENSIVE TREATMENT DURING NONSTEROIDAL ANTIINFLAMMATORY DRUG-THERAPY

Objective.-To determine whether there is an increased risk for the ini tiation of antihypertensive therapy in older persons prescribed nonasp irin, nonsteroidal antiinflammatory drugs (NSAIDs). Design.-Case-contr ol study. Setting.-New Jersey Medicaid program. Patients.-Medicaid enr ollees aged 65 years and older. The 9411 case patients were newly star ted on an antihypertensive medication between November 1981 and Februa ry 1990. A similar number of controls were randomly selected among oth er enrollees. Main Outcome Measures.-We used logistic regression to de termine the odds ratio for the initiation of antihypertensive therapy in patients using NSAIDs relative to nonusers, after adjusting for age , sex, race, nursing home residence, number of prescriptions filled, i ntensity of physician utilization, and days hospitalized. Results.-The adjusted odds ratio for the initiation of antihypertensive therapy fo r recent NSAID users compared with nonusers was 1.66 (95% confidence i nterval, 1.54 to 1.80). The odds ratio increased with increasing daily NSAID dose: the adjusted odds ratio for users of low average daily do ses relative to nonusers was 1.55 (95% Cl, 1.38 to 1.74), that for med ium-dose users was 1.64 (95% Cl, 1.44 to 1.87), and that for high-dose users was 1.82 (95% Cl, 1.62 to 2.05). Conclusions.-Use of NSAIDs may increase the risk for initiation of antihypertensive therapy in older persons. Given the high prevalence of NSAID use by elderly persons, t his association may have important public health implications for the management of hypertension in the older population.