Background Today, the cardiovascular side effects of non-steroidal anti-inflammatory drugs (NSAIDs) are known to attract more attention than the gastro-intestinal ones, with the destabilization of hypertension (HTN) being the most common among them.
Objectives To compare the levels of destabilization of HTN in patients with gouty arthritis (GA) receiving NSAIDs in ambulatory and hospital settings; to study factors contributing to the destabilization of HTN during hospitalisation period.
Methods 207 patients with GA were selected for the study. The diagnosis was based on the GA criteria (ACR, 1977). 88.9% of patients were males. The mean age was 57±9.9 years, the average duration of disease was 7.79±6.7 year s. NSAIDs were administered to the same patients in ambulatory and hospital settings. 48.8% (n=101) of ambulatory and 70% (n=145) of hospital patients received high doses of NSAIDs. Destabilized HTN was defined as sitting blood pressure (BP) ≥140/90 mm Hg and ≥150/90 mm Hg for patients aged ≥60 years. Ambulatory BP was checked at every visit; at the hospital, BP was measured on the first day of admission every 3 hours, if necessary, it was corrected, if increased, the 24h monitoring of BP was carried out. 28.5% (n=53) of patients had no pre-existing HTN or any antihypertensive drugs, and 71.5% (n=154) of patients suffered from HTN of various duration and severity.
Results Among ambulatory patients without HTN (HTN-), 28.3% (n=15) had elevated BP during the treatment period. Of 154 patients with GA and concomitant HTN (HTN+), increased BP was evidenced in 64.3% (n=99).
During the hospitalization, 18.9% (n=10) of HTN- patients presented with hypertensive reaction, thus, the number of new cases in outpatients was 5.7% (n=3). Among HTN+ patients, an elevated BP was observed in 40.25% (n=62), including 13% (n=20) new cases.
In 55.1% (n=114) of ambulatory patients, we observed unstable BP during the period of treatment with NSAIDs, while in the group of hospitalized patients, unstable HTN was reported in 34.8% (n=72). The difference between the number of patients with destabilized HTN in ambulatory and hospital settings was statistically significant (χ2 =17.22; p<0.0001). The total number of patients with elevated BP made 66.2% (n=137) during both phases of treatment with NSAIDs.
Only 55 HTN+ patients had stable BP during the ambulatory phase, but at a hospital setting, 20 of them developed elevated BP. It is worth to note that we found the only difference between the two groups: patients with destabilized HTN had more frequent hyperuricemia at the period of hospitalisation. (OR-5.32; 95%CI 1.4–20.2; p<0.05).
Conclusions There is a significant difference between the levels of destabilization of hypertension during the treatment with NSAIDs of patients with gouty attacks in ambulatory and hospital settings: 55.1% and 34.8%. This supposes that in ambulatory gouty patients under NSAIDs a careful control of their BP should be required, even with no history of pre-existing hypertension.
In spite of a rational antihypertensive therapy instable BP among patients with gouty arthritis receiving NSAIDs may be connected to hyperuricemia.
Disclosure of Interest None declared