November 2019
According to a study published in Arthritis Care and Research, the continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs) in those with ankylosing spondylitis (AS) can increase risk of hypertension. Continuous use refers to use on a regular, daily schedule determined by the prescribing physician and at a dose of at least 50% of the maximum daily recommendation, rather than occasional use as needed.
To study the correlation between NSAID use and rates of hypertension, researchers followed 628 AS patients, with no signs of hypertension at the time of enrollment in the study. Participants were chosen from a cohort of patients from the Prospective Study of Outcomes in AS. Among the 628 patients, 200 used NSAIDs continuously. During a median seven-year follow-up,129 (20.5%) of the participants had developed hypertension; 40% of those who developed hypertension were continuous NSAID users, 47% were using TNF inhibitors, and 16% were on both NSAIDs and TNF inhibitors. The study defines hypertension to meet one of the following criteria: patient-reported outcomes, the use of anti‐hypertensive medication, a systolic blood pressure of 140 mm Hg or greater, or a diastolic blood pressure of 90 mm Hg or greater, reported at two consecutive follow-up visits.
After controlling for other variables such as sex, age, disease activity, and TNF inhibitor use, researchers determined that continuous NSAID use was in fact associated with a significant, 12%, increased risk of hypertension compared to those who did not use NSAIDs or used them occasionally, as needed.
NSAIDs are the first-line pharmacologic treatment option recommended for AS, followed by TNF-inhibitors. Dr. Jean W. Liew, the lead author on the study, recommends that physicians discuss with their patients the risks and benefits of continuous use of NSAIDs, be more cautious about screening for cardiovascular risk factors, including hypertension, and to make sure that these conditions are treated in conjunction with primary care.
The study authors added that, “There is an unmet need to clarify how treatment choices, particularly the use of NSAIDs and TNF [inhibitors], impact CV [cardiovascular] risk factors and CV events in AS.”
***Dr. John Reveille, Dr. Michael Weisman, and Dr. Lianne Gensler, members of SAA’s Medical and Scientific Board, were contributing authors on this study.
Resources:
Cowen, Laura. “Continuous NSAID Use Linked to Hypertension Risk in Ankylosing Spondylitis.” Rheumatology.medicinematters.com, 2 Oct. 2019, rheumatology.medicinematters.com/ankylosing-spondylitis-/nsaids/nsaid-use-linked-hypertension-risk-ankylosing-spondylitis/17215324.
JW, Liew. “Continuous NSAID Use for AS Linked to Increased Hypertension Risk.” Healio, 3 Oct. 2019, www.healio.com/rheumatology/spondyloarthropathies/news/online/%7Bb2dc55ac-938f-43bb-b279-2797b09a1c7f%7D/continuous-nsaid-use-for-as-linked-to-increased-hypertension-risk.
Original Article:
Liew, J. W., Ward, M. M., Reveille, J. D., Weisman, M., Brown, M. A., Lee, M., Rahbar, M.,
Heckbert, S. R. and Gensler, L. S. (2019), Nonsteroidal Anti‐inflammatory Drug use is Associated with Incident Hypertension in Ankylosing Spondylitis. Arthritis Care Res. Accepted Author Manuscript. doi:10.1002/acr.24070
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