Controlling hypertension is a major component of maintaining heart health and preventing strokes. At the same time, however, adverse reactions to certain drugs—such as nonsteroidal anti-inflammatory drugs (NSAIDs), a group that includes aspirin, ibuprofen, and naproxen—remain an important cause of acute kidney injury, a condition that occurs in more than 20% of hospital inpatients and is associated with about half of all potentially preventable hospital deaths. Before the new BMJ study, little had been known about the increased risk of acute kidney injury from the interaction of antihypertensive drugs with NSAIDs, said the researchers, who are from Jewish General Hospital and McGill University in Montreal.
The researchers searched a database of 487 372 users of antihypertensive drugs with 6 years of follow-up data. They found 2215 patients with hypertension receiving triple therapy—consisting of diuretics, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin-receptor blockers (ARBs)—who were given an NSAID and were admitted to a hospital for acute kidney injury. This hospital admission rate was 31% higher than seen in a population of 21 993 patients who were receiving such triple therapy but not an NSAID. Patients taking triple therapy were 81% more likely to develop acute kidney injury in the first 30 days of taking an NSAID compared with patients who were taking triple therapy but not an NSAID. Patients who were taking a combination of 2 antihypertensive medications and who were given an NSAID had no increased risk of acute kidney injury.
The researchers acknowledged that the absolute risk for individuals is low (an incidence rate of 7 cases of acute kidney injury per 10 000 person-years) but said that their findings should remind physicians to be vigilant when aggressively treating hypertension with combination therapy while adding an NSAID to treat pain. “In particular, major attention should be paid early in the course of treatment, and a more appropriate choice among the available anti-inflammatory or analgesic drugs could therefore be applied in clinical practice,” they concluded.