Can I take naproxen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) if I have hypertension (high blood pressure)?

Naproxen Use in Patients with Hypertension

Naproxen should be used with caution in patients with hypertension, as it can worsen blood pressure control and potentially increase cardiovascular risk. If alternative pain management options are available, they should be considered first. 1

Effects of Naproxen on Blood Pressure

• NSAIDs, including naproxen, can lead to new hypertension or worsen pre-existing hypertension, which may contribute to increased cardiovascular events 1
• Naproxen can increase both systolic and diastolic blood pressure in patients taking antihypertensive medications, particularly those on ACE inhibitors and ARBs 2
• In hypertensive patients, naproxen has been shown to increase mean arterial pressure by approximately 3.74 mm Hg 3
• Even a modest increase of 5-6 mm Hg in diastolic blood pressure maintained over years may increase stroke risk by 67% and coronary heart disease events by 15% 4

Mechanism of Blood Pressure Elevation

• NSAIDs elevate blood pressure through several mechanisms:
  • Sodium and water retention 5
  • Renal vasoconstriction 6
  • Antagonism of antihypertensive medication effects, particularly with RAS inhibitors 2
  • Increased peripheral vascular resistance 4

Recommendations for Hypertensive Patients

• Blood pressure should be monitored closely during the initiation of NSAID treatment and throughout therapy 1
• For patients with inflammatory rheumatic diseases and hypertension, avoid high doses of NSAIDs when possible 5
• If naproxen must be used:
  • Use the lowest effective dose for the shortest possible duration 1
  • Monitor blood pressure more frequently, especially in the first few weeks of treatment 7
  • Be particularly cautious if the patient is also taking diuretics, as NSAIDs may impair response to these therapies 1

Alternative Pain Management Options

• Acetaminophen may be preferable for pain management in hypertensive patients, although it can still have minor effects on blood pressure 2
• In postpartum women with preeclampsia, guidelines specifically recommend avoiding NSAIDs if possible, especially in the setting of acute kidney injury 5
• For patients requiring both antihypertensive and NSAID therapy, vasodilators (including ACE inhibitors and calcium channel blockers) and diuretics may have less antagonism than beta-blockers 4

Special Considerations

• Patients at highest risk for adverse cardiovascular effects from naproxen include:

  • Those with known cardiovascular disease 1
  • Elderly patients 4
  • Patients with heart failure or fluid retention 1
  • Patients with poorly controlled hypertension 1

• Concomitant use of naproxen with the following medications requires extra caution:

  • Anticoagulants (increased bleeding risk) 5
  • Corticosteroids (increased gastrointestinal bleeding risk) 1
  • Multiple antihypertensive medications 2

Monitoring Recommendations

• Check blood pressure within 1-2 weeks after starting naproxen in hypertensive patients 7
• Monitor for signs of fluid retention (edema, weight gain) 1
• Be vigilant for gastrointestinal complications, which are also increased with NSAID use 1

Remember that even small increases in blood pressure can significantly impact cardiovascular risk over time, so careful consideration of the risk-benefit ratio is essential when prescribing naproxen to patients with hypertension.