From the Guidelines
Naproxen can cause a significant increase in blood pressure in the short term, with an estimated average increase of 5 mm Hg, as reported in a study published in the American Family Physician in 2009 1. This increase in blood pressure is a concern for individuals with existing hypertension or cardiovascular risk factors. The mechanism by which naproxen affects blood pressure involves the inhibition of prostaglandin production, leading to sodium retention, increased fluid volume, and vasoconstriction, resulting in elevated blood pressure. Key points to consider include:
- The effect of naproxen on blood pressure is usually dose-dependent, with higher doses more likely to cause noticeable increases than lower doses.
- People taking blood pressure medications may find their treatment becomes less effective when using naproxen.
- If naproxen must be taken while managing hypertension, it is recommended to use the lowest effective dose for the shortest duration possible and monitor blood pressure regularly.
- Individuals with heart disease, kidney problems, or who are elderly should be particularly cautious and consult their healthcare provider before using naproxen, as they are at higher risk for adverse cardiovascular effects, as noted in a statement from the American Heart Association published in Circulation in 2007 1.
From the FDA Drug Label
NSAIDs, including naproxen, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.
Naproxen and Blood Pressure: Naproxen can lead to the onset of new hypertension or worsening of pre-existing hypertension.
- Key Points:
- Naproxen can increase blood pressure
- Blood pressure should be monitored closely during treatment
- Clinical Decision: Naproxen may increase blood pressure in the short term, and blood pressure should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy 2 2.
From the Research
Effects of Naproxen on Blood Pressure
- Naproxen has been found to increase blood pressure in several studies 3, 4, 5, 6, 7
- A meta-analysis of 54 studies found that naproxen was associated with a significant increase in mean arterial pressure (MAP) of 3.74 mmHg 5
- Another study found that naproxen significantly increased clinic and ambulatory systolic/diastolic blood pressure (SBP/DBP) values in patients treated with ramipril or valsartan 4
- The PRECISION-ABPM trial found that naproxen increased mean 24-h systolic BP by 1.6 mmHg, although this change was not statistically significant compared to celecoxib 6
- Naproxen has been found to have a greater pressor effect compared to other NSAIDs, such as sulindac, and may antagonize the antihypertensive effect of certain medications, including diuretics, beta-blockers, and ACE inhibitors 7
Comparison to Other NSAIDs
- Ibuprofen has been found to have a greater increase in blood pressure compared to naproxen, with a change in mean 24-h systolic BP of 3.7 mmHg in the PRECISION-ABPM trial 6
- Celecoxib, a selective COX-2 inhibitor, has been found to have a smaller increase in blood pressure compared to naproxen and ibuprofen, with a change in mean 24-h systolic BP of -0.3 mmHg in the PRECISION-ABPM trial 6
- Other NSAIDs, such as indomethacin and piroxicam, have also been found to increase blood pressure, although the magnitude of the effect may vary 5, 7
Patient Populations
- Patients with hypertension may be more susceptible to the blood pressure-increasing effect of naproxen 3, 4
- The elderly and those with salt-sensitive hypertension may experience a greater rise in blood pressure with naproxen 7
- Patients taking antihypertensive medications, such as diuretics, beta-blockers, and ACE inhibitors, may be at increased risk of adverse interactions with naproxen 4, 7