A New Painkiller Danger

A recent study carried out by researchers at the Dept. of Cardiology, Univ. Heart Centre in Zurich, Switzerland, showed that ibuprofen can cause a dangerous rise in blood pressure.

According to an article posted on Aug. 28 on the Rheumatology Network website, a 4-month substudy of the landmark PRECISION trial was undertaken to “determine the blood pressure effects of the selective COX-2 inhibitor celecoxib [Celebrex] compared with the nonselective non-steroid anti-inflammation drugs (NSAIDs) naproxen [Aleve] and ibuprofen [Motrin, Advil, and Midol in the U.S.].

Called the PRECISION-ABPM, the study was “a prospective, double-blind, randomized, noninferiority cardiovascular safety trial, involved 60 sites in the United States. Of 444 patients, 408 (92 percent) had osteoarthritis and 36 (8 percent) had rheumatoid arthritis. All had evidence of, or were at increased risk for, coronary artery disease,” stated the article.

Many people with osteoarthritis are older, overweight, or obese, and suffer from hypertension (high blood pressure). While rheumatoid disease patients can contract the disease at any age, the inflammation it causes can affect the lining of the heart and lungs, increasing the risk of hypertension and cardiovascular disease. And because RD’s symptoms—joint pain, fatigue, and malaise—can keep people from exercising regularly, obesity and hypertension are common, particularly among older patients.

“The researchers randomized patients in a 1:1:1 fashion to receive celecoxib (100 to 200 mg twice a day), ibuprofen (600 to 800 mg 3 times a day), or naproxen (375 to 500 mg twice a day) with matching placebos. The change from baseline in 24-hour ambulatory blood pressure after four months was the primary end point.”

Striking Results

Almost everyone has popped ibuprofen (brand names Motrin, Advil, and Midol in the U.S.) to relieve pain at some time or another. It’s been around forever. You can buy it in your local drugstore or supermarket as a remedy for minor joint pain or menstrual pain. Some people use it to relieve muscle pain and headaches, backaches, or toothaches, and as a fever-reducer, as well. In its generic form, ibuprofen is one of the least-expensive pain-relievers available.

But you just might want to leave it right there on the shelf from now on.

Principle investigator Frank Ruschitzka, professor of cardiology and co-head, Dept. of Cardiology at the University Heart Centre, put the study results in plain language. “PRECISION-ABPM showed differential blood pressure effects between the different NSAIDs, ibuprofen and naproxen, and the COX-2 inhibitor celecoxib,” he said.

“While celecoxib and naproxen produced either a slight decrease (celecoxib) or a relatively small increase (naproxen) in blood pressure, ibuprofen was associated with a significant increase in ambulatory systolic blood pressure of more than 3 mmHg.”

Researchers did an additional analysis, as well. The results? “The percentage of patients with normal baseline blood pressure in whom hypertension developed was 23.2 percent for ibuprofen, 19.0 percent for naproxen, and 10.3 percent for celecoxib,” stated the article.

Again, Ruschitzka clarified. “Patients receiving ibuprofen had a 61 percent higher incidence of de novo [new] hypertension compared to those receiving celecoxib.”

“The current findings suggest that the elevated cardiovascular risk with NSAIDs may be partly due to drug-specific increases in blood pressure,” Professor Ruschitzka said. “PRECISION-ABPM clearly demonstrates that NSAIDs, particularly ibuprofen, may be not as safe as previously thought.

“Patients with osteoarthritis and arthritis should continue to consult their doctor before taking NSAIDs or coxibs, and clinicians need to weigh the potential hazards of worsening blood pressure control when considering the use of these agents.

“Since decreasing systolic blood pressure by just 2 mmHg lowers stroke mortality by 10 percent and ischemic heart disease mortality by 7 percent,” Ruschitzka concluded, “increases in systolic blood pressure associated with NSAIDs as observed in PRECISION-ABPM should be considered clinically relevant.”

In other words, the study’s conclusions are worth paying close attention to.

Oh, and One More Thing …

Ibuprofen, like other NSAIDs, can also play merry h**l with your stomach. It “can cause ulcers, bleeding, or holes in the stomach or intestine,” according to the National Institutes of Health. Again, always check with your rheumatologist before taking ibuprofen or any other OTC NSAID.

Author's Note: The dosages of ibuprofen and other NSAIDs mentioned in the referenced Rheumatology Network article are clinical doses (1,800-2,400 mg/day), which are higher than the highest dose of ibuprofen one would normally take while taking the over-the-counter version of this drug (1.200 mg/day).
Please remember to use ibuprofen and all other medications, whether prescribed or OTC, exactly as directed by your physician or on the label.

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