If you have high blood pressure, you should avoid taking non-steroidal anti-inflammatory drugs (NSAIDs), including the ibuprofen which you can buy from pharmacies and supermarkets. Doctors have known since the 1990s that NSAIDs can raise blood pressure, but now it’s also known that these common painkillers can increase your risk of associated complications such as heart attack, stroke, heart failure and dangerous heart rhythms, too. These recognised side effects are still not widely appreciated, however, and an estimated one in ten adults takes NSAIDs regularly (at least three times a week for at least 3 months of the year) and their use is increasing.
How ibuprofen raises blood pressure
NSAIDs such as ibuprofen, naproxen and diclofenac work by blocking enzymes (COX-1 and/or COX-2) that regulate the production of hormone-like prostaglandins. Prostaglandins are produced in platelets (blood clotting factors) and in blood vessel walls, and play a role in blood vessel dilation and kidney function, as well as having a damping down effect on inflammation and pain.
These NSAID painkillers cause blood pressure to rise by increasing the sensitivity of blood vessels to the constricting effects of stress hormones. NSAIDs also neutralise the blood pressure lowering effects of some antihypertensive drugs, and increase the risks associated with having uncontrolled high blood-pressure such as heart attack, stroke and heart failure.
NSAIDs reduce the effectiveness of antihypertensive drugs
In people whose blood pressure was previously controlled on medication, starting an NSAID can worsen their blood pressure readings. The size of this effect depends partly on the individual and on the blood pressure medication they are taking.
When researchers checked the records of 1,340 people with hypertension who used NSAIDs and 1,340 people who used acetaminophen (paracetamol), they found that NSAID use was associated with a 2 mmHg higher systolic blood pressure (upper figure) overall. In those taking an ACE inhibitor or calcium channel blocker to control their hypertension, NSAID use increased systolic blood pressure by an average of 3 mmHg. In those taking a beta-blocker antihypertensive drug, systolic blood pressure was 6 mmHg higher, on average.
Previous studies have reported as much as a 7 mmHg increase in blood pressure in people who take an NSAID such as ibuprofen plus a beta-blocker drug, and up to a 10 mmHg rise in blood pressure in people combining ibuprofen with an ACE inhibitor drug.
NSAIDs can increase blood pressure within 4 weeks
A study involving 787 people with both hypertension and osteoarthritis, assessed the effects of starting ibuprofen on their blood pressure control (using an ambulatory BP monitor). Taking ibuprofen for four weeks, at the commonly prescribed dose of 600 mg three times daily, significantly worsened blood pressure control – especially in those taking an angiotensin receptor blocker or an ACE inhibitor antihypertensive drug.
- In people receiving angiotensin receptor blockers (ARBs) antihypertensive therapy, systolic blood pressure readings worsened by 8.1 mmHg when taking ibuprofen (compared to another NSAID called lumiracoxib which has since been withdrawn due to adverse effects on the liver).
- For patients receiving an ACE inhibitor, the estimated increase in blood pressure due to ibuprofen was 8.2 mmHg.
- In those taking a beta-blocker, the increase in blood pressure was 5.8 mmHg.
- For patients taking a diuretic ibuprofen caused blood pressure to rise by 3.6mmHg.
- For those on a calcium channel blocker, taking ibuprofen for 4 weeks caused systolic blood pressure to increase by 2.8mmHg.
So which painkiller is best if you have high blood pressure?
If you have high blood pressure and a painful condition such as osteoarthritis, which requires regular non-steroidal anti-inflammatory painkiller, whatever you do, avoid taking ibuprofen. Talk to your doctor about whether or not another type of painkiller might suit you better.
Bear in mind that pain, in itself, can raise blood pressure, so it is important to find a safe way to control your symptoms. A topical pain-relieving cream or gel is worth trying, for example. The amount of diclofenac absorbed through the skin when using a Voltarol gel is a drop in the ocean compared to the amount absorbed into the circulation when taken by mouth. Having said that, read the Voltarol Emulgel Patient Information Leaflet within the pack carefully, as applying the gel to multiple sites is not recommended, and the area covered is usually just the zie from 1 penny to a 2 pence piece! If you overuse Voltarol Gel, your blood pressure could well go up so monitor it carefully. Paracetamol is also effective for some people, but not for others.
Different NSAIDs have different cardiovascular safety profiles, and it may be that a prescription-only version called celecoxib does not have such a significant effect on blood pressure readings. A recent study found that taking celecoxib to treat osteoarthritis or rheumatoid arthritis was even associated with a small reduction in systolic blood pressure of 0.3mmHg (compared to a 3.7mmHg increase with ibuprofen and a 1.6mmHg increase with naproxen). Having said that, over the course of this 4 month study, new cases of hypertension (described using the ‘old’ definition as an average 24 hour reading of ≥130/80 mmHg) occurred in 23.2% of those taking ibuprofen, 19% in those taking naproxen, and 10.3% in those receiving celecoxib. These new cases were at least partly due to the effects of the pain killing medication being taken, so, celecoxib doesn’t suit everyone.
Whenever you start a new medicine (or supplement) it’s vitally important to monitor your blood pressure regularly to see if your hypertensive control changes.
If your blood pressure is raised, self-monitoring is key to maintaining good control.
Click here for advice on choosing a blood pressure monitor to use at home.
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