Can aceclofenac be given to patients with severe uncontrolled hypertension?

Aceclofenac Should Not Be Given to Patients with Severe Uncontrolled Hypertension (200/120 mmHg)

Aceclofenac is contraindicated in patients with severe uncontrolled hypertension (200/120 mmHg) due to the significant risk of hemorrhagic stroke and worsening of hypertension. 1

Rationale for Contraindication

Risk of Hemorrhagic Stroke

• In patients with uncontrolled severe hypertension who are taking NSAIDs like aceclofenac, blood pressure should be lowered without delay to reduce the risk of hemorrhagic stroke 1
• The American Heart Association specifically warns that NSAIDs should be used with caution in patients with hypertension due to their association with:
  • Increased blood pressure
  • Peripheral edema
  • Weight gain
  • Worsening renal function 1

Medication Interference with Blood Pressure Control

• NSAIDs are among the most prevalent medications that interfere with blood pressure control 2
• They can counteract the effects of many antihypertensive medications, making it more difficult to achieve target blood pressure levels
• In a patient with already severely elevated blood pressure (200/120 mmHg), introducing an NSAID would further complicate blood pressure management

Priority Management for Severe Hypertension

Immediate Blood Pressure Lowering

• For patients with BP of 200/120 mmHg, immediate blood pressure reduction is the priority
• The European Society of Cardiology recommends prompt initiation of pharmacological treatment along with lifestyle measures for confirmed BP ≥140/90 mmHg 1
• In this severe case (200/120 mmHg), the risk is significantly higher and requires urgent intervention

Recommended Antihypertensive Approach

1. Combination therapy is recommended as initial treatment for most patients with confirmed hypertension 1
2. Preferred combinations include:
   • A RAS blocker (ACE inhibitor or ARB) with a dihydropyridine CCB or diuretic 1
   • For resistant hypertension, a three-drug combination is recommended (RAS blocker + dihydropyridine CCB + thiazide/thiazide-like diuretic) 1

Alternative Pain Management Options

If pain management is necessary for this patient, consider:

1. Acetaminophen (paracetamol) at appropriate doses
2. Non-pharmacological pain management strategies
3. Once blood pressure is controlled (ideally to 120-129 mmHg systolic), reassess the need for pain medication 1
4. If NSAID therapy becomes necessary after blood pressure control, close monitoring would be required

Conclusion

Aceclofenac, like other NSAIDs, should be avoided in patients with severe uncontrolled hypertension. The priority should be to achieve blood pressure control first, using appropriate antihypertensive medications, before considering the use of NSAIDs for pain management.