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.
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