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NSAIDs can be used safely in some patients with hypertension, heart failure, CKD

Despite guidelines recommending against the use of NSAIDs in patients with hypertension, heart failure and chronic kidney disease, they are frequently prescribed to such high-risk patients in primary care settings; however, NSAID use was not associated with a higher risk for safety-related outcomes, according to findings published in JAMA Internal Medicine.

“International nephrology societies advise against NSAID use in patients with hypertension, heart failure, or chronic kidney disease (CKD); however, recent studies have not investigated the frequency or associations of use in these patients,” Zachary Bouck, MPH, from the Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, and colleagues wrote.

Bouck and colleagues conducted a retrospective cohort study to determine the frequency of, characteristics of, and variations in prescription NSAID use among high-risk patients. They also evaluated the association between NSAIDs and several cardiovascular and renal safety-related outcomes, including death, cardiac complications, defined as any ED visit or hospitalization for CVD, and renal complications, defined as any hospitalization for hyperkalemia, acute kidney injury or dialysis.

The researchers examined 2,415,291 musculoskeletal-related primary care visits by 814,049 older adults (mean age, 75.3 years; 61.1% women) with hypertension, heart failure or CKD. Participants categorized as using prescription NSAIDs were those with at least one patient-level Ontario Drug Benefit claim for a prescription NSAID that was dispensed within 7 days after a visit.

Results showed that 9.3% (n = 224,825) of visits resulted in prescription NSAID use. Among 7,365 primary care physicians, there was a median physician-level prescribing rate of 11%, but rates varied widely.

The cohort consisted of 35,552 patient pairs matched based on their propensity score for prescription NSAID use. Among the matched patient pairs, the rates of cardiac complications (288 vs. 279), renal complications (34 vs. 33) and death (27 vs. 30) were similar. Additionally, exposed (n = 308; 0.9%) and nonexposed patients (n = 300; 0.8%) showed no difference in cardiovascular and renal safety-related outcomes (absolute risk reduction = 0.0003; 95% CI, –0.001 to 0.002).

“Future studies on the optimal strategies to manage musculoskeletal pain in this patient population should be undertaken,” Bouck and colleagues concluded. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.