Pain relief drugs called COX inhibitors seem to reduce the blood pressure-lowering effects of ACE inhibitors, a group that includes drugs like Zestril and Monopril, new research suggests. This drug interaction seems to occur even when newer COX inhibitors, such as Celebrex (celecoxib) and Vioxx (rofecoxib), are used. However, these newer agents don't seem to cause kidney problems that can occur with older pain relievers, such as Voltaren, Motrin and Relafen. "Physicians need to be alerted to these effects on blood pressure and kidney function and to monitor blood pressure accordingly in all patients receiving" COX inhibitors, Dr. George L. Bakris and colleagues, from Rush Medical Center in Chicago, note.
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The report is published in Hypertension: Journal of the American Heart Association. The researchers examined the effects of Celebrex and Voltaren on blood pressure and kidney function in 25 patients with arthritis and high blood pressure being treated with an ACE inhibitor. Among other conditions, COX inhibitors are used to treat the pain and inflammation that occurs with arthritis. At four weeks, Voltaren worsened overall blood pressure control more than Celebrex in patients who were also taking an ACE inhibitor, the team reports. However, at peak drug levels, Voltaren and Celebrex had similar effects on blood pressure. "We showed that in the presence of ACE inhibitors, kidney function was worsened more with" Voltaren than with Celebrex, Bakris told Reuters Health. In fact, even though a diuretic, or "water pill," was given, the kidney impairment triggered by Voltaren led to ankle swelling. In contrast, no ankle swelling was seen with Celebrex. High blood pressure and arthritis commonly co-exist in the elderly, leading to frequent co-administration of COX inhibitors and ACE inhibitors, the authors point out in their report. They believe their study provides "new information" regarding the blood pressure and kidney effects of using these two drug classes at the same type.
SOURCE: Hypertension, March 2004.