A meta-analysis of 50 studies in patients or healthy subjects found that
NSAIDs elevated
mean supine blood pressure by 5 mmHg. Ibuprofen, indometacin and
piroxicam produced the greatest increases. Aspirin and
sulindac produced the smallest increases in blood pressure and the effects of diclofenac, flurbiprofen,
naproxen and tiaprofenic acid were intermediate. However, there seems to be little evidence that a clinically significant interaction occurs in most patients taking
calcium-channel blockers.
Although the risks of
NSAIDs with
calcium-channel blockers may be less than those with other antihypertensive drugs, until more information is available, caution has been recommended. It has been suggested that the use of
NSAIDs should be kept to a minimum in patients with hypertension. The effects may be greater in the elderly and in those with blood pressures that are relatively high, as well as in those with high salt intake.