Hypertension, or high blood pressure, is a leading cause of death and disability in the U.S. The Centers for Disease Control and Prevention reports that the majority of people who have heart failure or experience their first stroke or heart attack have hypertension. Even a slight increase in your blood pressure can increase your risk for a stroke or heart attack, if it is persistent. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Motrin, Advil), indomethacin (Indocin) and piroxicam (Feldene), can increase your blood pressure whether or not you already have hypertension.
Reduced Kidney Blood Flow
Your kidneys are intimately involved in controlling your blood pressure. When they sense a decrease in blood flow, your kidneys release the hormone renin. This hormone triggers blood vessel constriction and sodium and water retention. These adjustments elevate your blood pressure, which improves blood flow to your kidneys.
Kidney blood flow is also regulated by prostaglandins, a group of substances that dilate blood vessels and promote inflammation. NSAIDs inhibit prostaglandin production, which reduces inflammation throughout your body. But when prostaglandin levels in your kidneys fall, blood flow diminishes. Renin is released in response and your blood pressure ultimately rises.
Loss of Blood Pressure Control
Doctors have been aware of the blood pressure-raising effects of NSAIDs for many years. According to a November 1997 review in "Drug Safety," NSAID use triggers a 5-point increase in average blood pressure, which could be a problem if your blood pressure is already higher than it should be. NSAID users are 40 percent more likely to be diagnosed with hypertension than nonusers and are nearly twice as likely to be started on medications to control their blood pressure.
People whose hypertension is already controlled are more likely to see significant increases in their blood pressure when they take NSAIDs. This finding suggests that people with preexisting hypertension are particularly susceptible to the blood pressure-destabilizing effects of NSAIDs.
NSAIDs Are Not Equal
Although NSAIDs have been linked to increased blood pressure, some drugs in this class may have a more significant effect on your blood pressure than others. In an article published in the November 2010 issue of "Circulation," the authors reported the results of an analysis of 8 studies involving the effect of NSAIDs on blood pressure. The researchers concluded that indomethacin and ibuprofen provoke the largest increases in blood pressure, while celecoxib (Celebrex) and naproxen (Aleve, Naprosyn) and are associated with smaller changes.
The effects of a single daily aspirin on blood pressure are usually insignificant, but if you take several doses of aspirin each day to reduce inflammation, your blood pressure could go up. Some studies showed that blood pressure elevation can occur within 2 weeks after starting a NSAID. Before taking a NSAID, ask your doctor for recommendations, especially if you have hypertension.
NSAIDs are among the most commonly used medications in the U.S. Over-the-counter and prescription NSAIDs are used for both acute and chronic medical problems, including fever control, pain relief following injuries and long-term treatment of arthritis. Many people who take NSAIDs -- mature adults with arthritis, for example -- also take medications for high blood pressure.
The availability of NSAIDs lulls people into believing they are completely safe. Like any medication, however, they do have side effects and their use should be monitored by a medical professional. If you are taking an NSAID, ask your doctor if your blood pressure should be checked.
- Centers for Disease Control and Prevention: High Blood Pressure Facts
- Drug Safety: NSAIDs and Increased Blood Pressure: What Is the Clinical Significance?
- Physiology and Behavior: The Renin Angiotensin System and the Metabolic Syndrome
- Circulation: Blood Pressure Destabilization on Non-Steroidal Anti-Inflammatory Agents: Acetaminophen Exposed?