Johnson A G, Nguyen T V, Day R O
St. Vincents Hospital, Sydney, Australia.
Ann Intern Med. 1994 Aug 15;121(4):289-300. doi: 10.7326/0003-4819-121-4-199408150-00011.
A meta-analysis of randomized trials studying the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure.
Eight databases were searched, yielding 38 randomized, placebo-controlled trials and 12 randomized but not placebo-controlled trials (comparing two or more NSAIDs).
Pooled mean treatment effects were computed in each trial for blood pressure, weight, creatinine clearance, plasma renin activity, and daily urinary excretion of sodium and prostaglandins. Meta-analyses of these variables were done for all randomized, controlled trials; for all randomized, uncontrolled trials; and for several subgroups.
When pooled, NSAIDs elevated supine mean blood pressure by 5.0 mm Hg (95% CI, 1.2 to 8.7 mm Hg) but had no effect on variables other than blood pressure. Nonsteroidal anti-inflammatory drugs antagonized the antihypertensive effect of beta-blockers (blood pressure elevation, 6.2 mm Hg; CI, 1.1 to 11.4 mm Hg) more than did vasodilators and diuretics. Among NSAIDs, piroxicam produced the most marked elevation in blood pressure (6.2 mm Hg; CI, 0.8 to 11.5 mm Hg), whereas sulindac and aspirin had the least hypertensive effect.
Nonsteroidal anti-inflammatory drugs may elevate blood pressure and antagonize the blood pressure-lowering effect of antihypertensive medication to an extent that may potentially increase hypertension-related morbidity. Although certain NSAIDs and antihypertensive agents could be more likely to produce these effects, the underlying mechanisms require further study.
对研究非甾体抗炎药（NSAIDs）对血压影响的随机试验进行荟萃分析。
检索了八个数据库，得到38项随机、安慰剂对照试验以及12项随机但非安慰剂对照试验（比较两种或更多种NSAIDs）。
计算每项试验中血压、体重、肌酐清除率、血浆肾素活性以及钠和前列腺素每日尿排泄量的合并平均治疗效果。对所有随机对照试验、所有随机非对照试验以及几个亚组进行这些变量的荟萃分析。
汇总后，NSAIDs使仰卧位平均血压升高5.0 mmHg（95%可信区间，1.2至8.7 mmHg），但对血压以外的变量无影响。非甾体抗炎药对β受体阻滞剂降压作用的拮抗作用（血压升高6.2 mmHg；可信区间，1.1至11.4 mmHg）大于血管扩张剂和利尿剂。在NSAIDs中，吡罗昔康使血压升高最为显著（6.2 mmHg；可信区间，0.8至11.5 mmHg），而舒林酸和阿司匹林的升压作用最小。
非甾体抗炎药可能会升高血压，并在一定程度上拮抗抗高血压药物的降压作用，这可能会增加与高血压相关的发病率。尽管某些NSAIDs和抗高血压药物更有可能产生这些影响，但其潜在机制仍需进一步研究。
