Oates J A
Vanderbilt University School of Medicine, Nashville, Tennessee 37232.
Hypertension. 1988 Mar;11(3 Pt 2):II4-6. doi: 10.1161/01.hyp.11.3_pt_2.ii4.
Certain nonsteroidal anti-inflammatory drugs antagonize the action of antihypertensive therapy. Indomethacin has been shown to abrogate the antihypertensive effect of beta-adrenergic receptor blockers, diuretics, converting enzyme inhibitors, and several antihypertensive drug combinations, and the accumulated evidence on piroxicam indicates that it also raises arterial pressure in treated patients. In contrast, sulindac and aspirin do not reverse the effects of antihypertensive drugs, and currently available data indicate that they are the safest cyclooxygenase inhibitors for use in hypertensive patients. In the absence of definitive information on the array of other nonsteroidal anti-inflammatory drugs, they should be considered to pose a risk similar to indomethacin until proved otherwise. The magnitude of the elevation in blood pressure varies between patients, ranging from no effect to dangerous hypertensive responses. Generalized inhibition of the cyclooxygenase enzyme has opposing effects on arterial pressure, lowering renin on one hand and causing sodium retention on the other. Some evidence suggests that cyclooxygenase inhibition causes the greater increments in pressure in patients who initially have low plasma renin activity (often the elderly). The potential for cerebral vascular catastrophes attends these drug interactions in which platelet function also is suppressed by cyclooxygenase inhibition.
某些非甾体抗炎药会拮抗抗高血压治疗的作用。已证实吲哚美辛可消除β-肾上腺素能受体阻滞剂、利尿剂、转化酶抑制剂及几种抗高血压药物组合的降压效果，并且有关吡罗昔康的累积证据表明，它也会使接受治疗患者的动脉血压升高。相比之下，舒林酸和阿司匹林不会逆转抗高血压药物的作用，目前可得的数据表明，它们是用于高血压患者的最安全的环氧化酶抑制剂。在缺乏关于其他非甾体抗炎药系列的确切信息的情况下，在未被证明无风险之前，应认为它们具有与吲哚美辛类似的风险。血压升高的幅度在患者之间有所不同，从无影响到危险的高血压反应。环氧化酶的普遍抑制对动脉血压有相反的作用，一方面降低肾素，另一方面导致钠潴留。一些证据表明，环氧化酶抑制在最初血浆肾素活性较低的患者（通常为老年人）中会导致更大的血压升高。脑血管灾难的可能性伴随着这些药物相互作用，在这些相互作用中，血小板功能也会因环氧化酶抑制而受到抑制。
