Differential Blood Pressure Effects Of Ibuprofen Naproxen And Celecoxib In Patients With Arthritis: The Precision
on behalf of the PRECISION-ABPM Investigators
The first two authors contributed equally to the study.
Dedicated to the memory of Henry Krum.
Committees, study centres, and investigators participating in the PRECISION-ABPM Trial are listed in the , Appendix.
European Heart Journal
Ibuprofen More Likely To Raise Bp Than Naproxen Or Celecoxib
NEW YORK Ibuprofen boosts blood pressure more than naproxen or celecoxib in patients who take non-steroidal anti-inflammatory drugs to treat arthritis, according to a new substudy from the PRECISION trial.
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These drugs are different with regard to BP, and ibuprofen is the worst, Dr. Frank Ruschitzka of University Hospital Zurich in Switzerland, the studys first author, tells Reuters Health.
In 2015, the U.S. Food and Drug Administration strengthened its warning on the cardiovascular risks of over-the-counter NSAIDs and cyclooxygenase 2 inhibitors, Dr. Ruschitzka and his team note in their Aug. 28 online report in the European Heart Journal.1 Clinicians face difficult decisions on how to treat patients who take NSAIDs regularly to treat arthritis, they add, many of whom also have hypertension.
The PRECISION randomized trial, funded by celecoxib maker Pfizer and mandated by the FDA, compared the three drugs in patients with arthritis who either had cardiovascular disease or were at increased risk. Published in the New England Journal of Medicine in 2016, PRECISION showed that celecoxibs cardiovascular safety was non-inferior to that of naproxen or ibuprofen.
In the new PRECISION prespecified substudy, 444 arthritis patients underwent 24-hour ambulatory BP monitoring at baseline and after four months on celecoxib , ibuprofen or naproxen . Mean baseline BP was 125/75 mmHg and very similar among the groups.
Ibuprofen Increases Blood Pressure In Patients With Arthritis
volume 14, pages 632633
Use of the NSAID ibuprofen is associated with an increase in blood pressure and higher incidence of new-onset hypertension compared with use of the NSAID celecoxib in patients with osteoarthritis or rheumatoid arthritis. These findings, presented at the ESC Congress 2017 and simultaneously published in the European Heart Journal, come from a prespecified, 4-month substudy of the PRECISION trial.
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Aspirin And Nonselective Nsaids
Two meta-analyses evaluated aspirin trials that included data on blood pressure.1,2 Aspirin dosages were greater than 1.5 g per day. There was no statistically significant effect on blood pressure. In a trial of 18,700 patients with hypertension, participants were randomized to receive aspirin or placebo for a mean of 3.8 years.3 There was no effect on blood pressure. There were significant reductions in rates of myocardial infarction among participants who were also receiving angiotensin-converting enzyme inhibitors .
A systematic review identified 32 randomized controlled trials that included 3,626 patients who were treated for at least four weeks with nonselective NSAIDs.4 Patients were monitored for changes in blood pressure and rates of hypertension during treatment. Most studies enrolled patients with osteoarthritis or rheumatoid arthritis, although some included patients with other conditions. Patients who received ibuprofen had a greater incidence of new hypertension compared with those in the control group .
Million American Adults Have At Least One Type Of Cardiovascular Disease2
When recommending an analgesic, its important to consider patients heart risks. The combination of certain pain relievers with some medicinal therapies can interfere with cardiovascular treatment. Because of its safety and analgesic efficacy, the American Heart Association has identified acetaminophen as a first-line pain relief option for patients with, or at high risk for, cardiovascular disease.3*
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You Don’t Know Your Numbers
If you don’t check your blood pressure, you won’t know if there’s a potential problem. Data from the National Health and Nutrition Examination Survey shows that 13 million people in the United States are not aware that they have hypertension and therefore are not making lifestyle changes or taking medication to help control it.
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Having High Blood Pressure And Ibuprofen Being Taken
If you are a high blood pressure patient, a doctor should carefully weigh the use of any type of over the counter medications. This includes any medication that contains aspirin in it.
So first have a talk with your doctor about the type of pain reliever you should take if you are on an aspirin regimen, too.
High blood pressure and ibuprofen seem to go hand in hand in terms of the increased risks associated with ibuprofen.
High Blood Pressure And Ibuprofen: What You Need To Know
If you are taking aspirin for high blood pressure and ibuprofen is something you wish to use, be careful about making the switch. Ibuprofen is not the same in terms of what it can do for individuals who have high blood pressure.
In fact, those who are taking a regimen for aspirin are warned not to take ibuprofen because it can offset the benefits of the aspirin.
Aspirin works to thin the blood, which makes the heart’s job of pumping the blood through your body easier. It also works as an anti-inflammatory as well as a resource for pain.
However, many doctors are now prescribing a daily low dose of aspirin for those who have cardiovascular risks, including risks for strokes and heart attacks.
The benefits of aspirin are simply not found in ibuprofen.
In fact, doctors warn against taking both of these medications at the same time. The combination can cause stomach pain and can lead to blood clotting, which further leads to an increased risk of stroke and heart attack.
In fact, in one study conducted, there was evidence that those who took both aspirin and ibuprofen had nearly twice the risk of death from any type of cause. Further, they had a 73 percent increased risk of death from heart disease.
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You Have A Beer Every Day Or Many On Weekends
It has long been known that heavy drinking can boost blood pressure. Research presented at the American College of Cardiology’s annual scientific meeting demonstrated that even moderate alcohol consumptionseven to 13 drinks per weeksubstantially raises a person’s risk for hypertension. Data for the research came from the large, decades-long NHANES study that followed 17,000 U.S. adults between 1988 and 1994. Researchers found that compared with people who never drank, moderate drinkers were 53% more likely to have stage 1 hypertension and twice as likely to have stage 2, while heavy drinkers were 69% more likely to have stage 1 hypertension and 2.4 times as likely to have stage 2.
So Which Painkiller Is Best If You Have High Blood Pressure
If you have high blood pressure and a painful condition such as osteoarthritis, which requires regular non-steroidal anti-inflammatory painkiller, whatever you do, avoid taking ibuprofen. Talk to your doctor about whether or not another type of painkiller might suit you better.
Bear in mind that pain, in itself, can raise blood pressure, so it is important to find a safe way to control your symptoms. A topical pain-relieving cream or gel is worth trying, for example. The amount of diclofenac absorbed through the skin when using a Voltarol gel is a drop in the ocean compared to the amount absorbed into the circulation when taken by mouth. Having said that, read the Voltarol Emulgel Patient Information Leaflet within the pack carefully, as applying the gel to multiple sites is not recommended, and the area covered is usually just the zie from 1 penny to a 2 pence piece! If you overuse Voltarol Gel, your blood pressure could well go up so monitor it carefully. Paracetamol is also effective for some people, but not for others.
Whenever you start a new medicine its vitally important to monitor your blood pressure regularly to see if your hypertensive control changes.
If your blood pressure is raised, self-monitoring is key to maintaining good control.
Image credits: pixabay
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Ibuprofen And High Blood Pressure: A Dangerous Reaction
Use of nonsteroidal anti-inflammatory drugs is on the rise . Were talking about drugs like ibuprofen and naproxen. Such pain relievers are perceived as quite safe, since they have been available over the counter for decades. But there is growing evidence that prescription NSAIDs like celecoxib, diclofenac and meloxicam, as well as OTC ibuprofen and naproxen, can impact blood pressure. There are also concerns about heart attacks and other cardiovascular complications. The higher the dose the greater the risk, as this reader discovered.
Ibuprofen And High Blood Pressure
Q. My doctor prescribed 800 mg of ibuprofen a couple of times a day for the pain and inflammation of a severely twisted knee. When I took my blood pressure a few weeks later it was 180/96. Thats much higher than my usual 124/76.
That scared me, so I searched your website for answers. I discovered that ibuprofen and high blood pressure can go together. What else can I use for the pain?
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Ibuprofen Associated With Blood Pressure Rise In Arthritis Patients At Cardiovascular Risk
- European Society of Cardiology
- Ibuprofen is associated with increased blood pressure and hypertension compared to celecoxib in patients with osteoarthritis or rheumatoid arthritis and increased risk of cardiovascular disease, according to new research.
Ibuprofen is associated with increased blood pressure and hypertension compared to celecoxib in patients with osteoarthritis or rheumatoid arthritis and increased risk of cardiovascular disease, according to late-breaking results from the PRECISION-ABPM study presented today in a Hot Line Session at ESC Congress1 and published in EHJ.
Nonsteroidal anti-inflammatory drugs , both non-selective and selective cyclooxygenase-2 inhibitors, are among the most widely prescribed drugs worldwide, but are linked with increased blood pressure and adverse cardiovascular events. Indeed, 19% of the US population use at least one NSAID on a regular basis, including 30 million Americans with osteoarthritis, of whom more than 40% also have hypertension.
NSAID labels include warnings about potential increases in blood pressure but there is little data on the effects of individual drugs. Maintaining or achieving blood pressure control in patients with arthritis and concomitant hypertension could avoid more than 70,000 deaths from stroke and 60,000 deaths from coronary heart disease each year,2 making it important to investigate the effects of various NSAIDs on blood pressure.
Stay Away From These Pain Relievers If You Have High Blood Pressure Heart Failure Or Kidney Disease: The Frugal Patient
People with high blood pressure, heart failure and kidney disease should avoid ibuprofen, sold under the brand names Advil and Motrin, and some other pain relievers because they can cause complications. Acetaminophen, sold as Tylenol, is the best first option, according to the Choosing Wisely campaign.
Some pain relievers, such as ibuprofen, can be bad for you if you have high blood pressure, heart failure or kidney disease.
The drugs are called NSAIDs, short for nonsteroidal anti-inflammatory drugs, and are sold under the names Advil, Motrin, Aleve and the prescription drug Celebrex.
They can cause all kinds of problems for people who have the above-listed health conditions.
They can, for example, raise blood pressure or make a body hold onto fluid, which can worsen heart failure symptoms such as shortness of breath and swollen ankles.
If you have any of these conditions its best to take acetaminophen, sold as Tylenol, instead. But never take more than 4,000 milligrams a day. High doses can damage the liver.
All this advice comes from
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If You Have Type 2 Diabetes
There are few factors that you should consider if you have type 2 diabetes and are wondering if its okay to take a couple of ibuprofen for your headache, backache, or fever.
Many people with type 2 diabetes take metformin to help them control their blood sugar levels. Metformin belongs to a class of drugs known as biguanides.
Metformin lowers the amount of glucose that your liver makes and the amount of glucose that you absorb from the food you eat. It also has some anti-inflammatory effects. Some research suggests that metformin may interact with ibuprofen and other analgesics.
One 2017 study suggested that they actually interacted synergistically and that lower doses of ibuprofen would be adequate for a person already taking metformin to get the pain relief they needed. But that study was conducted with animals, and more research is needed.
Chronic kidney disease
You may also need to steer clear of ibuprofen if you have kidney disease. A large retrospective published in 2014 found that people with type 2 diabetes who took NSAIDs for at least 90 days were more likely to develop chronic kidney disease than people who didnt take any NSAIDs.
suggests that people who are receiving treatment with sulfonylureas, which is used to stimulate the beta cells in your pancreas to release more insulin, might be at increased risk for hypoglycemia.
Since sulfonylureas can potentially lead to low blood sugar anyway, ibuprofen might compound the effect.
Cautions With Other Medicines
Ibuprofen doesn’t mix well with some medicines.
Ibuprofen applied to the skin is less likely to interfere with other medicines than if it’s taken by mouth.
For safety, tell your doctor if you’re taking these medicines before you start taking ibuprofen by mouth or using it on your skin:
- blood-thinning medicines such as warfarin
- anti-inflammatory painkillers such as aspirin, diclofenac, mefenamic acid and naproxen
- antidepressants such as citalopram, fluoxetine, fluvoxamine, venlafaxine, paroxetine or sertraline
- diabetes medicines such as gliclazide, glimepiride, glipizide and tolbutamide
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How To Keep High Blood Pressure At Bay
SATURDAY, Oct. 17, 2020 — To mark World Hypertension Day this Saturday, the American Heart Association offers advice on how to lower and control your blood pressure.
High blood pressure affects nearly half of American adults, and three-quarters of those with high blood pressure don’t have it under control, the heart association says.
High blood pressure is the leading cause of heart attack and stroke, and the most significant controllable risk factor for these conditions. It also contributes to poor outcomes in COVID-19 patients.
“Now, more than ever, it is important for you to pay attention to your blood pressure, know your numbers, work with your health care provider to control your levels and manage your risks. Lowering your blood pressure is one of the most important things you can do to reduce your risk of having a heart attack or stroke,” Dr. Mitchell Elkind, president of the American Heart Association , said in an AHA news release.
Small changes can make a big difference in managing your blood pressure. Here are some tips:
Can Ibuprofen Be Taken If I Have High Blood Pressure
Medications in this drug group have a tendency to increase blood pressure, but your susceptibility to it might be different than the next person.
Susceptibility will depend on many factors, such as genetics, other drugs you may currently be taking, the supplements you may be consuming, general diet, and whether or not you exercise.
If you have issues with blood pressure, its usually recommended that you consult a doctor before taking medications that may worsen your blood pressure. Your doctor should be able to give you a test regimen and provide blood workups and blood pressure checks to see how youll personally react to taking ibuprofen and other NSAIDs
This is NOT something you want to ignore . If youre struggling with blood pressure take a look at this:
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High Blood Pressure and OTC Pain Medications
In this episode we talk about common over the counter medications used for aches, pains, and fever and how they can increase your blood pressure.
Disclaimer: Please talk with your pharmacist or physician before starting or changing the way you take any of your medications.
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