NSAID–antihypertensive combinations may risk kidney damage

By Sally Robertson, B.Sc.Jan 14 2013

Physicians should be aware that treating patients with a combination of antihypertensives along with nonsteroidal anti-inflammatory drugs (NSAIDs) may cause kidney damage, say researchers.

"In particular, major attention should be paid early in the course of treatment, and a more appropriate use and choice among the available anti-inflammatory or analgesic drugs could therefore be applied in clinical practice," suggest Samy Suissa (McGill University, Montreal, Quebec, Canada) and colleagues.

The team's analysis showed that a triple therapy combination consisting of a diuretic, an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), and an NSAID was associated with a substantially increased risk for acute kidney injury.

Using information from the UK Clinical Practice Research Datalink and the Hospital Episodes Statistics Database, the team found that of 487,372 individuals prescribed antihypertensives between 1997 and 2008, 2215 developed acute kidney injury over a mean follow-up period of 5.9 years.

Analysis showed no increased risk among patients taking NSAIDs at the same time as receiving antihypertensive monotherapy with a diuretic, ACE inhibitor, or ARB.

However, patients who took NSAIDs concurrently with the combination of a diuretic and ACE inhibitor or ARB had a 31% increased risk for acute kidney injury, driven primarily by a nearly twofold increased risk in the first 30 days of treatment.

"Although the basis of this is still unclear, it might be explained by an early and severe deteriorating effect of NSAIDs in susceptible patients, who are heavily dependent on prostacyclins to maintain renal function," say Suissa and team. "Furthermore, patients may initially use a greater number of NSAID pills early on than later, as some causes of pain may abate over time."

Given the wide use of NSAIDs, increased vigilance may be warranted when such a triple combination is used, says the team.

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