Alternative to NSAIDs should be considered for patients with CAD, hypertension

Chronic self-reported use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with coronary artery disease (CAD) and hypertension is associated with harmful outcomes and alternative methods of pain relief should be considered, according to a study in the July issue of The American Journal of Medicine.

To establish data about the safety of chronic NSAIDs in hypertensive patients with CAD, researchers conducted a post hoc analysis from the INternational VErapamil Trandolapril STudy (INVEST), which was an international randomized trial conducted in 14 countries that enrolled patients with hypertension and CAD from September 1997 to February 2003. At each visit, patients were asked by the local-site investigator if they were currently taking aspirin or NSAIDs.

For the purpose of the recent analysis, researchers categorized patients who reported NSAID use at baseline and each follow-up as chronic NSAID users, while all patients who reported never taking NSAIDS or only occasionally were defined as nonchronic NSAID users. The primary composite outcome was all-cause death, nonfatal myocardial infarction, or nonfatal stroke. Cox regression was used to construct a multivariate analysis for the primary outcome.

Chronic self-reported NSAID use by hypertensive patients with CAD over a mean of 2.7 years was associated with a 47% increase in the first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke, due to a 90% increase in all-cause mortality, a 126% increase in cardiovascular mortality, and a 66% increase in total myocardial infarctions. Researchers reported that it was unknown if a particular agent was responsible for the excess risk.

“Among coronary artery disease patients with hypertension, chronic self-reported use of NSAIDs was associated with harmful outcomes, and this practice should be avoided where possible. This association did not appear to be due to elevated blood pressure because chronic NSAID users actually had slightly lower on-treatment blood pressure over a mean of 2.7 years of follow-up. Until further data are available, alternative modes of pain relief should be considered for these patients,” the authors wrote.