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.