Publication: Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: Joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations
Issued Date
2020-04-01
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ISSN
14683288
00175749
00175749
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2-s2.0-85078048858
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Mahidol University
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SCOPUS
Bibliographic Citation
Gut. Vol.69, No.4 (2020), 617-629
Suggested Citation
Cheuk Chun Szeto, Kentaro Sugano, Ji Guang Wang, Kazuma Fujimoto, Samuel Whittle, Gopesh K. Modi, Chen Huen Chen, Jeong Bae Park, Lai Shan Tam, Kriengsak Vareesangthip, Kelvin K.F. Tsoi, Francis K.L. Chan 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. Vol.69, No.4 (2020), 617-629. doi:10.1136/gutjnl-2019-319300 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/53723
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Title
Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: Joint APAGE/APLAR/APSDE/APSH/APSN/PoA recommendations
Other Contributor(s)
Jichi Medical University
National Yang-Ming University Taiwan
Saga University
SungKyunKwan University, School of Medicine
Mahidol University
The University of Adelaide
Chinese University of Hong Kong
Asia-Pacific Society for Digestive Endoscopy (APSDE)
Asian Pacific Association of Gastroenterology (APAGE)
Asia Pacific League of Associations for Rheumatology (APLAR)
Asia Pacific Society of Hypertension (APSH)
Asian Pacific Society of Nephrology (APSN)
Samarpan Kidney Institute and Research Center
Shanghai Institute of Hypertension
National Yang-Ming University Taiwan
Saga University
SungKyunKwan University, School of Medicine
Mahidol University
The University of Adelaide
Chinese University of Hong Kong
Asia-Pacific Society for Digestive Endoscopy (APSDE)
Asian Pacific Association of Gastroenterology (APAGE)
Asia Pacific League of Associations for Rheumatology (APLAR)
Asia Pacific Society of Hypertension (APSH)
Asian Pacific Society of Nephrology (APSN)
Samarpan Kidney Institute and Research Center
Shanghai Institute of Hypertension
Abstract
© 2020 Author(s). 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.