Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used by rheumatic patients for both acute and chronic conditions. A certain increase in blood pressure of 3–5 mmHg seems to be a NSAID class effect. Although the effect appears from the beginning of the treatment, due to his“modest” amplitude, it was largely ignored both by patients and physicians. However, new epidemiological data suggest that such a small increase in BP could produces in USA about 21.000 deaths per year (higher than in case of gastrointestinal deaths produced by the unprotected usage of nonselective NSAID). For the time being we do know that topical and systemic NSAID have similar therapeutic effect on superficial exposed joints (e.g. knee, wrists, elbows etc).
Objectives The aim of the study was to evaluate whether or not the use of topical NSAIDs in rheumatic patients affects blood pressure or pulse rate values.
Methods This was a prospective study which included patients diagnosed with various rheumatic diseases using a continuous Automated BP Monitoring (ABPM): both BP and pulse rate have been continuously recorded for 48 hours at baseline (24 hours without topical NSAID use) and day1 (24 hours with topical NSAID use). Same NSAID (namely Aceclofenac) in same dose was used in all cases. Subjects that changed their concomitant medication have been excluded from the analyses. Daytime (0700–2200), nighttime (2201–0659) and all-day (24h) systolic and diastolic BP along with pulse rate values have been analyzed. Difference between Baseline and Day1 have been tested by using ANOVA and Fisher exact test; a p<0.05 was considered significant.
Results 15 subjects have been evaluated between October 2015 to January 2016. The meanSystolic BP varied between 101.75 and 147.9 in Baseline respectively between 103.9 and 132.25 during D1. The mean diastolic BP varied between 55.5 – 88.1 in Baseline and respectively between 56.4–82.5 during D1. Pulse varied between 60.2 and 95.9 in Baseline and respectively 59.3 and 90.2 during Day1. No difference between baseline and Day1 have been identified for Systolic or DiastolicBP, cardiac pulse; same results have been obtained for all-day, nighttime and daytime subanalysis.
Conclusions Although this study has certain limitations our data suggest no significant change in BP or cardiac pulse associated to topic use of NSAID (in our case Aceclofenac). Larger studies should be made to confirm the conclusion of this pilot study.
Snowden S, Nelson R- The effects of nonsteroidal anti-inflammatory drugs on blood pressure in hypertensive patients. Cardio Rev2011 Jul-Aug;19(4):184–91.
Howard Lee,MD; KeeSikKim,MD,- Ambulatory Blood Pressure Response to Once-Daily Fimasartan: An 8-Week, Multicenter, Randomized, Double- Blind, Active-Comparator, Parallel-Group Study in Korean Patients With Mild To Moderate Essential Hypertension Clinical Therapeutics/Volume 35, Number 9, 2013.
Disclosure of Interest None declared