Houston M C, Weir M, Gray J, Ginsberg D, Szeto C, Kaihlenen P M, Sugimoto D, Runde M, Lefkowitz M
Vanderbilt University Medical Center, Nashville, Tenn, USA.
Arch Intern Med. 1995 May 22;155(10):1049-54.
Nonsteroidal anti-inflammatory drugs may attenuate the antihypertensive effects of diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, central alpha-agonists, and other vasodilators. Their effects on the antihypertensive efficacy of calcium channel blockers are inadequately studied in small numbers of patients but appear to be minimal.
A three-phase, randomized, double-blind, placebo-controlled multicenter study included 162 patients aged 18 to 75 years with essential hypertension. After diastolic blood pressure was controlled to 90 mm Hg or less with once-daily verapamil hydrochloride, patients received ibuprofen, naproxen, or placebo matching capsules for 3 weeks, and blood pressure, heart rate, weight, and adverse effects were evaluated. A general linear model with 95% confidence intervals was used to compare each nonsteroidal anti-inflammatory drug treatment group with the placebo group.
No significant differences in sitting, standing, or supine blood pressure were noted with naproxen or ibuprofen compared with placebo. The percentages of patients in each treatment group with increases of 10 mm Hg or more in either systolic or diastolic blood pressure were similar. Statistically significant increases in weight were seen with both nonsteroidal anti-inflammatory drug therapies. Changes in pulse rate were not significant. The incidence of adverse effects was similar across all three treatment groups.
The addition of naproxen or ibuprofen to the treatment of hypertensive patients in whom blood pressure is controlled by once-daily verapamil does not cause an increase in blood pressure. Verapamil may therefore offer considerable advantages in maintaining control of blood pressure in patients who regularly receive nonsteroidal anti-inflammatory drug therapy.
非甾体抗炎药可能会减弱利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂、中枢性α激动剂及其他血管扩张剂的降压作用。在少数患者中对其对钙通道阻滞剂降压疗效的影响研究不足，但似乎影响极小。
一项三阶段、随机、双盲、安慰剂对照的多中心研究纳入了162例年龄在18至75岁的原发性高血压患者。在使用每日一次的盐酸维拉帕米将舒张压控制在90mmHg或更低后，患者接受布洛芬、萘普生或安慰剂匹配胶囊治疗3周，并评估血压、心率、体重及不良反应。使用具有95%置信区间的一般线性模型将每个非甾体抗炎药治疗组与安慰剂组进行比较。
与安慰剂相比，萘普生或布洛芬治疗组在坐位、站立位或仰卧位血压方面无显著差异。每个治疗组中收缩压或舒张压升高10mmHg或更多的患者百分比相似。两种非甾体抗炎药治疗均观察到体重有统计学意义的增加。脉搏率变化不显著。所有三个治疗组的不良反应发生率相似。
在使用每日一次维拉帕米控制血压的高血压患者治疗中加用萘普生或布洛芬不会导致血压升高。因此，维拉帕米在定期接受非甾体抗炎药治疗的患者维持血压控制方面可能具有相当大的优势。
