Effect of naproxen and acetaminophen on blood pressure lowering by ramipril,
valsartan and aliskiren in hypertensive patients.
Author(s): Gualtierotti R(1), Zoppi A, Mugellini A, Derosa G, D'Angelo A, Fogari R.
Affiliation(s): Author information:
(1)University of Milan, Division of Rheumatology, Istituto G. Pini, Department of
Clinical Sciences and Community Health , P.za Cardinal Ferrari 1, 20122 Milan ,
Italy +3958296272 ; +3958296315 ; roberta.gualtierotti@unimi.it.
Publication date & source: 2013, Expert Opin Pharmacother. , 14(14):1875-84
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used
for reducing pain and other symptoms in osteoarthritis (OA). NSAIDs have been
associated with an increase in blood pressure (BP) in both normotensive and
hypertensive individuals and a blunting effect on various anti-hypertensive
medications. Acetaminophen effects on anti-hypertensive treatment, instead, are
still a matter of debate.
OBJECTIVES: To assess the effect of naproxen versus acetaminophen on ramipril,
valsartan and aliskiren therapy in hypertensive patients with OA in a
double-blind, cross-over study, by measuring clinic, ambulatory BP and heart rate
(HR).
RESULTS: One hundred seventy four patients were randomly treated with ramipril,
valsartan or aliskiren for 8 weeks and 135 patients with normalized BP were
randomized to receive naproxen or acetaminophen for 2 weeks. Naproxen
significantly increased clinic and ambulatory systolic/diastolic BP (SBP/DBP)
values in patients treated with ramipril (p < 0.01) or valsartan (p < 0.05), but
did not affect aliskiren effects. Also acetaminophen slightly but significantly
affected clinic and ambulatory SBP/DBP in all three groups and, surprisingly, it
also produced a slight increase in HR (+3.1, +3.3 and +3.4 b/min day-time HR
values, for ramipril, valsartan and aliskiren, respectively; p < 0.05).
CONCLUSIONS: Both naproxen and acetaminophen can affect anti-hypertensive therapy
with ramipril, valsartan or aliskiren with a different extent. When acetaminophen
is chosen for OA management in subjects with hypertension, patients should be
evaluated as carefully as when traditional NSAIDs are given.
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