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Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations.
Gut 2020Gut

Abstract

BACKGROUND

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications, but they are associated with a number of serious adverse effects, including hypertension, cardiovascular disease, kidney injury and GI complications.

OBJECTIVE

To develop a set of multidisciplinary recommendations for the safe prescription of NSAIDs.

METHODS

Randomised control trials and observational studies published before January 2018 were reviewed, with 329 papers included for the synthesis of evidence-based recommendations.

RESULTS

Whenever possible, a NSAID should be avoided in patients with treatment-resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). Before treatment with a NSAID is started, blood pressure should be measured, unrecognised CKD should be screened in high risk cases, and unexplained iron-deficiency anaemia should be investigated. For patients with high cardiovascular risk, and if NSAID treatment cannot be avoided, naproxen or celecoxib are preferred. For patients with a moderate risk of peptic ulcer disease, monotherapy with a non-selective NSAID plus a proton pump inhibitor (PPI), or a selective cyclo-oxygenase-2 (COX-2) inhibitor should be used; for those with a high risk of peptic ulcer disease, a selective COX-2 inhibitor plus PPI are needed. For patients with pre-existing hypertension receiving renin-angiotensin system blockers, empirical addition (or increase in the dose) of an antihypertensive agent of a different class should be considered. Blood pressure and renal function should be monitored in most cases.

CONCLUSION

NSAIDs are a valuable armamentarium in clinical medicine, but appropriate recognition of high-risk cases, selection of a specific agent, choice of ulcer prophylaxis and monitoring after therapy are necessary to minimise the risk of adverse events.

Authors+Show Affiliations

Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong. Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong.Jichi Medical University, Shimotsuke, Tochigi, Japan. Asian Pacific Association of Gastroenterology (APAGE), Tochigi, Japan.Shanghai Institute of Hypertension, Shanghai, Shanghai, China. Asia Pacific Society of Hypertension (APSH), Shanghai, China.Saga University, Saga, Japan. Asia-Pacific Society for Digestive Endoscopy (APSDE), Saga, Japan.The University of Adelaide, Adelaide, South Australia, Australia. Asia Pacific League of Associations for Rheumatology (APLAR), Adelaide, South Australia, Australia.Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong. Samarpan Kidney Institute and Research Center, Bhopal, India.National Yang-Ming University, Taipei, Taiwan. Pulse of Asia (PoA), Taipei, Taiwan.Pulse of Asia (PoA), Taipei, Taiwan. Dankook University College of Medicine, Cheonam, Chungcheongnam-do, Korea (the Republic of).Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong. Asia Pacific League of Associations for Rheumatology (APLAR), Adelaide, South Australia, Australia.Asian Pacific Society of Nephrology (APSN), Hong Kong, Hong Kong. Mahidol University, Nakorn Pathom, Thailand.Chinese University of Hong Kong, New Territories, Hong Kong kelvintsoi@cuhk.edu.hk.Chinese University of Hong Kong, New Territories, Hong Kong.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31937550

Citation

Szeto, Cheuk-Chun, et al. "Non-steroidal Anti-inflammatory Drug (NSAID) Therapy in Patients With Hypertension, Cardiovascular, Renal or Gastrointestinal Comorbidities: Joint APAGE/APLAR/APSDE/APSH/APSN/PoA Recommendations." Gut, 2020.
Szeto CC, Sugano K, Wang JG, et al. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations. Gut. 2020.
Szeto, C. C., Sugano, K., Wang, J. G., Fujimoto, K., Whittle, S., Modi, G. K., ... Chan, F. K. L. (2020). Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations. Gut, doi:10.1136/gutjnl-2019-319300.
Szeto CC, et al. Non-steroidal Anti-inflammatory Drug (NSAID) Therapy in Patients With Hypertension, Cardiovascular, Renal or Gastrointestinal Comorbidities: Joint APAGE/APLAR/APSDE/APSH/APSN/PoA Recommendations. Gut. 2020 Jan 14; PubMed PMID: 31937550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations. AU - Szeto,Cheuk-Chun, AU - Sugano,Kentaro, AU - Wang,Ji-Guang, AU - Fujimoto,Kazuma, AU - Whittle,Samuel, AU - Modi,Gopesh K, AU - Chen,Chen-Huen, AU - Park,Jeong-Bae, AU - Tam,Lai-Shan, AU - Vareesangthip,Kriengsak, AU - Tsoi,Kelvin K F, AU - Chan,Francis K L, Y1 - 2020/01/14/ PY - 2019/07/01/received PY - 2019/12/06/revised PY - 2019/12/22/accepted PY - 2020/1/16/entrez KW - aspirin KW - bleeding peptic ulcer KW - cardiovascular disease KW - non-steroidal anti-inflammatory drugs KW - portal hypertension JF - Gut JO - Gut N2 - BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications, but they are associated with a number of serious adverse effects, including hypertension, cardiovascular disease, kidney injury and GI complications. OBJECTIVE: To develop a set of multidisciplinary recommendations for the safe prescription of NSAIDs. METHODS: Randomised control trials and observational studies published before January 2018 were reviewed, with 329 papers included for the synthesis of evidence-based recommendations. RESULTS: Whenever possible, a NSAID should be avoided in patients with treatment-resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). Before treatment with a NSAID is started, blood pressure should be measured, unrecognised CKD should be screened in high risk cases, and unexplained iron-deficiency anaemia should be investigated. For patients with high cardiovascular risk, and if NSAID treatment cannot be avoided, naproxen or celecoxib are preferred. For patients with a moderate risk of peptic ulcer disease, monotherapy with a non-selective NSAID plus a proton pump inhibitor (PPI), or a selective cyclo-oxygenase-2 (COX-2) inhibitor should be used; for those with a high risk of peptic ulcer disease, a selective COX-2 inhibitor plus PPI are needed. For patients with pre-existing hypertension receiving renin-angiotensin system blockers, empirical addition (or increase in the dose) of an antihypertensive agent of a different class should be considered. Blood pressure and renal function should be monitored in most cases. CONCLUSION: NSAIDs are a valuable armamentarium in clinical medicine, but appropriate recognition of high-risk cases, selection of a specific agent, choice of ulcer prophylaxis and monitoring after therapy are necessary to minimise the risk of adverse events. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/31937550/Non-steroidal_anti-inflammatory_drug_(NSAID)_therapy_in_patients_with_hypertension,_cardiovascular,_renal_or_gastrointestinal_comorbidities:_joint_APAGE/APLAR/APSDE/APSH/APSN/PoA_recommendations L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&pmid=31937550 DB - PRIME DP - Unbound Medicine ER -