What are NSAIDS
The most commonly prescribed and over the counter painkillers are nonsteroidal anti-inflammatory drugs (NSAID) consisting of aspirin, naproxen, diclofenac, ketorolac, and ibuprofen. These drugs provide analgesic (pain-killing) and antipyretic (fever-reducing) effects, and, in higher doses, anti-inflammatory effects. They are usually used for the treatment of acute or chronic conditions where pain and inflammation are present.
How do they work
Selective NSAIDs work by inhibiting the formation of prostaglandins which cause inflammation, white blood cell recruitment, pain and stimulate the hypothalamic fever response via the COX-2 pathway.
Non-selective NSAIDS block the inflammatory reactions mentioned above and also block the gastric mucosal lining production and platelet aggregation via the COX-1 pathway. Blocking the production of the mucosal lining increases the risk of damage to the stomach
Aspirin, the only NSAID able to irreversibly inhibit COX-1, is also indicated for inhibition of platelet aggregation. This is useful for the management of arterial thrombosis and prevention of adverse cardiovascular events. Aspirin inhibits platelet aggregation by inhibiting the action of thromboxane A2.
How do they influence Hypertension
The widespread use of NSAIDs has meant that the adverse effects of these drugs have become increasingly common. NSAIDs are believed to cause hypertension by antagonizing the anti-hypertensive effect of the drugs or by affecting renal function. They are known to cause renal injury and dysfunction. Prostaglandins (PGs) maintain renal hemodynamics and protect renal tubular function. Reduced synthesis of these prostaglandins due to NSAIDS increases the risk of renal injury. Research measuring renal glomerular filtration rate reported a significant increase in kidney filtration when NSAIDs are removed. NSAIDs also cause salt and water retention through mechanisms not fully understood, however, it is believed that the reduced blood flow leads to a reduction in the filtered load of sodium.
On the contrary, diclofenac and piroxicam are the only NSAIDs statistically associated with hypertension treatment intensification. This should also be considered when choosing an appropriate treatment.
Physicians and healthcare providers must bear in mind the effects of NSAIDs while prescribing these agents especially when it comes to patients with hypertension or who are at risk of developing high blood pressure and also when dealing with patients with renal failure.
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- Zheng, L., & Du, X. (2014). Non-steroidal anti-inflammatory drugs and hypertension. Cell Biochemistry and Biophysics, 69(2), 209-11. doi:http://dx.doi.org/10.1007/s12013-013-9791-5.
- Fournier, J., Sommet, A., Bourrel, R., Oustric, S., Pathak, A., Lapeyre-mestre, M., & Montastruc, J. (2012). Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: A population-based cohort study. European Journal of Clinical Pharmacology, 68(11), 1533-40. doi:http://dx.doi.org/10.1007/s00228-012-1283-9