Nonsteroidal anti-inflammatory drugs and hypertension. The risks in perspective.

摘要: Prostaglandins play an important role in cardiovascular homeostasis. Among other things, they promote vasodilation and enhance sodium excretion. Since act as local hormones, it is difficult to assess their activity the intact organism. Nonsteroidal anti-inflammatory drugs (NSAIDs) block synthesis of prostaglandins, thus may interfere with circulatory control. Indeed, many reports show that blood pressure rise during treatment one these drugs. However, meta-analyses such indicate mean arterial relatively small, being approximately 5 mm Hg. At present time, not known whether this confers any risk terms complications. Moreover, trials on which information based are short duration. Whether increment following administration NSAIDs sustained over time has been established. Also, there insufficient regarding special subgroups population who at developing hypertension exposure NSAIDs. Some data suggest elderly people patients pre-existing carry increased risk, notably when receiving antihypertensive treatment. Available all equal far effect concerned. Sulindac, perhaps also aspirin, seem be less troublesome respect than This applies effects kidney. Unfortunately, mechanisms whereby raise fully understood. Interference both control vascular resistance regulation extracellular volume homeostasis incriminated, but several putative moderation adrenergic or resetting baroreceptor response involved. For practising physician, wise balance increase against expected benefit NSAID. In (treated) elderly, benefits always outweigh admittedly small risk. Should physician nevertheless decide prescribe NSAID, frequent measurement necessary first weeks