Thursday, January 17, 2013

NSAIDS Combined With High Blood Pressure Meds Damage Kidneys

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) reduce pain. Common NSAIDS are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve), all of which are available over the counter. Prescription NSAIDS include Celebrex and at one time Vioxx (withdrawn because it increased risk for heart attack and stroke).

NSAIDS are losing favor as a safe pain reliever. They:
  • Raise blood pressure and when taken consistently can contribute to hypertension.
  • Adversely affect the kidneys. (They decrease the kidney's filtration rate (Glomerular Filtration Rate: GFR) and cause sodium and fluid retention.)
  • Increase risk for bleeding.
  • Increase risk for heart attack in healthy people.
  • Increase risk for stroke in healthy people. One cheap 200 mg Advil tablet increased stroke risk up to 90%.
  • Damage joints and bone.

Now it appears NSAIDS can severely damage the kidney when taken with antihypertensive agents:
Concurrent Use Of Diuretics, Angiotensin Converting Enzyme Inhibitors, And Angiotensin Receptor Blockers With Non-Steroidal Anti-Inflammatory Drugs And Risk Of Acute Kidney Injury: Nested Case-Control Study, British Medical Journal, January 2013
Taking these 3 drugs together - a diuretic, an ACE inhibitor or angiotensin receptor blocker (ARB), and an NSAID - significantly increased the risk for kidney injury requiring hospitalization.

As I've seen, diuretics plus ARBs or ACE inhibitors are commonly prescribed together for high blood pressure. In an older population that often faces pain from chronic inflammatory conditions, NSAIDS are a frequent add-on.

This quote by the study's lead author is for you, Claudia:
"He [senior author Dr. Samy Suissa] adds that the study findings are indicative of how hypertension is now being managed. "It's being controlled with two drugs, not just one, and then if you have pain, we will add an NSAID to that. In our cohort of antihypertensive-drug patients, 11% were treated with this triple therapy, which is quite large. We were surprised."
That 11% says nothing of the Advil and Motrin people pick up at Walgreens and Target.

If you take NSAIDS more than occasionally (once or twice a month, or for many months), even over-the-counter Advil, you should be under a doctor's care. If you have kidney disease (which frequently accompanies diabetes) or high blood pressure or have a history of heart attack or stroke, it's wise to consult with an MD prior to taking any NSAID.

This information isn't fringe or extremist or meant to be alarmist. Here's a video by the mainstream and generally reliable Consumer Reports that iterates everything above, except for the results of the recent study about antihypertensives. It's had only 35 views since July. I don't think people care, or at least they aren't paying attention. The information it contains is current, factual, and relayed in a succinct and accessible manner.



Bix said...

Note that NSAIDS can raise blood pressure, and can contribute to hypertension. Which would invite a prescription for antihypertensives. Which when taken with the NSAIDs raise risk for kidney failure. This house-of-cards drug scenario is the specter of modern-day healthcare.

Claudia said...

"We were surprised." haha.. I'll bet you anything someone else wasn't surprised! Everyone is always telling you they already know! I believe them more that they say they were surprised. They're honest.

Seriously the guys at the gym take 4 advil before working out, 4 advil after, 4 before going to bed. Like it's good for weightlifting.

Claudia said...

Bix did you see this?

Bix said...

In fact, someone sent that story to me. I agree with it. I've seen quite a few first-person accounts masquerading as journalism. I guess I feel more comfortable reading a story where n>1.