There is evidence that most NSAIDs
(including the coxibs) can increase blood pressure in patients taking antihypertensives
, including ACE inhibitors
, although some studies have not found the increase to be clinically relevant. Indometacin appears to have the most significant effect. The combination of an NSAID
and an ACE inhibitor may increase the risk of renal
impairment, and rarely, hyperkalaemia has been associated with the combination.
Only some patients are affected. Consider increasing the frequency of blood pressure monitoring if an NSAID
is started. Monitor renal
function and electrolytes periodically.