NSAIDs and antihypertensive agents

Mixing certain antihypertensive agents with nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of renal failure, according to a new study. In a retrospective cohort study of nearly 500,000 users of antihypertensive drugs in the United Kingdom, rate ratios of acute kidney injury associated with current use of certain antihypertensive agents with NSAIDs were assessed. After a mean follow-up of 5.9 years, 2215 cases of acute kidney injury were identified. Overall, current use of a single antihypertensive (either diuretics, angiotensin-converting enzyme inhibitors [ACEIs], or angiotensin receptor blockers [ARBs]), along with an NSAID was not associated with increased rate of acute injury. However, combining a diuretic with either an ACEI or ARB along with an NSAID increased the rate of acute kidney injury significantly (rate ratio 1.31, 95% CI, 1.12-1.53). This 31% increased risk of acute kidney injury was driven by a nearly two-fold increased risk in the first 30 days of use. The authors conclude that triple therapy consisting of diuretics with an ACEI or ARB along with an NSAID was associated with an increased risk of acute kidney injury, especially at the start of treatment (BMJ published online January 8, 2013. doi.org/10.1136/bmj.e8713).