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Question: Why do we need to be careful with over-the-counter (OTC) pain medicines if we have hypertension (high blood pressure)?
Answer: We all need pain relief at some time or other. In fact, pain is so ubiquitous that some medications are accessible over-the-counter to help us manage it on a day-to-day basis.
However, individuals who are hypertensive must be mindful about the pain medications they take. In particular, one class of pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) – which also reduce inflammation (heat, redness, stiffness, swelling,) and fever – can be dangerous for hypertensive patients. The popular over-the-counter NSAIDs in Jamaica are Ibuprofen (Advil) and Naproxen (Aleve).
Pain is the result of two types of signals to the brain – electrical and chemical. The nerves in the affected area send electrical distress signals to the brain. Additionally, the damaged tissue produces chemicals, called prostaglandins, and this causes swelling in the affected area. These prostaglandins also send a message to the brain. The electrical and chemical signals indicate to the brain that there is a problem, and this results in you feeling pain. NSAIDs work by blocking the production of prostaglandins, thus reducing pain and swelling.
While NSAIDs are fantastic pain relievers, they also have a range of side effects. The most prominent side effects are gastrointestinal (stomach upset, ulcers), allergies, and their effects on the blood pressure and kidneys.
How NSAIDs affect blood pressure and kidneys
NSAIDs are circulated throughout the body, so, unfortunately, they do not focus only on prostaglandins at the site of the pain. They affect prostaglandins in other areas of the body as well. For example, the kidneys produce prostaglandins that keep the blood vessels supplying the kidneys wide open to increase blood flow. NSAIDs block the production of these kidney prostaglandins, resulting in reduced blood supply to the kidneys. This reduced blood supply causes the kidneys to start working more slowly.
The kidneys’ main function in the body is to remove toxins, excess salts such as sodium, and water through urine. If the kidneys start working more slowly, the body will retain excess toxins, sodium, and water. Sodium and water retention in the body leads to increased blood volume, and ultimately, increased blood pressure. This can eventually lead to kidney damage. For a hypertensive patient, this is certainly not a welcome series of events.
Taking NSAIDs also increases the risk of heart attack and stroke. These medications increase the likelihood of blood clots forming in the body, and these clots can have the detrimental effects of potentiating these life-threatening conditions. As a hypertensive patient, you are already at increased risk for heart attack and stroke. There is no need to take a painkiller that is going to increase this risk even further. If you need to take an NSAID pain reliever, please first discuss it with your doctor so you can be properly monitored.
In addition to directly affecting the blood pressure by way of the kidneys, NSAIDs can impair the effects of blood pressure medicines, making them less effective. Medications such as Enalapril, Losartan, Carvedilol, and diuretics (water pills) will not be able to carry out their blood pressure-reducing function well in the presence of NSAIDs.
Diuretics help to reduce blood pressure by expelling salt and water from the body through urine. That is why diuretics make you pee more often. NSAIDs cause the body to retain water because of their effect on the kidneys. Hence, they directly work against the diuretics, making the treatment less effective.
While other drugs such as Enalapril, Losartan, and Carvedilol do not produce their antihypertensive effect in the kidneys, they still experience decreased effectiveness when taken with NSAIDs, simply because NSAIDs increase the blood pressure. This sort of antagonistic effect causes the management of hypertension to be extremely difficult.
If you are taking blood pressure medications and your blood pressure is not controlled, check if you are taking over-the-counter NSAIDs. If so, discontinue those pain medications immediately. Instead, Paracetamol/Acetaminophen (Panadol, Cetamol) should be your go-to over-the-counter pain reliever. If that is not sufficient, please see your doctor for a painkiller that is appropriate for you.
Novia Jerry Stewart, MSc, RPh, is a pharmacist who specialises in ophthalmic care. She earned a Bachelor of Pharmacy degree at the University of Technology, Jamaica and a Master of Science in General Management at Walden University in Minnesota, USA. She also has a Certificate in Diabetic Retinopathy Grading from the University of Melbourne, Australia, and a Diploma in Opticianry from the University of Central Florida. She may be contacted at firstname.lastname@example.org.