Do not use non-steroid anti-inflammatory drugs (NSAID) in subjects with arterial hypertension, heart failure, renal insufficiency from any cause, including diabetes.

Do not use non-steroid anti-inflammatory drugs (NSAID) in subjects with arterial hypertension, heart failure, renal insufficiency from any cause, including diabetes.

Type of practice

Drugs

Age

Adult, Geriatric

Topic Area

Hospital Internal Medicine

NSAIDs and 2 cyclooxygenase inhibitors (anti-COX-2) – although widely used even without a medical prescription – can cause important side effects including increased blood pressure, lower response to antihypertensive treatments, water retention and worsening of renal function in patients with hypertension, heart failure, renal failure from any etiology including diabetes. Furthermore, the use of NSAIDs has been associated with a significantly higher risk of coronary heart disease, stroke (in patients with or without heart disease or risk factors for heart disease), and heart failure. The risk increases as the taken doses increase. In patients with type 2 diabetes, NSAIDs have been associated with an increased risk of first hospitalization for heart failure, particularly in patients with advanced age, and elevated HbA1c levels. The most recent guidelines for the treatment of chronic pain in subjects affected by these pathologies, mostly if elderly, recommend limiting the use of NSAIDs as much as possible, preferring the use of paracetamol, tramadol and short-life opiates as an alternative.

Sources

1. NKF. NKF KDOQI clinical practice guidelines. http://www.kidney.org/professionals/KDOQI/guidelines_ckd. (last accessed March 2024).
2. NIH. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure http://www.nhlbi.nih.gov/files/docs/guidelines/jnc7full.pdf. (last accessed March 2024).
3. NICE. Chronic heart failure in adults: diagnosis and management. http://pathways.nice.org.uk/pathways/chronic-heart-failure. (last accessed March 2024).
4. Whittle SL, Colebatch AN, Buchbinder R, et al. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a board panel of rheumatologists in the 3e Initiative. Rheumatology 2012; 51:1416-25. doi: 10.1093/rheumatology/kes032.
5. FDA. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory. (last accessed March 2024).

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.