Protect your kidneys

It isn’t easy to be a heart patient, there are so many medication and lifestyle consideration to prevent further injury or illness.

Common heart medication interact with our foods and other medications.  NSAIDS increase heart problems, Coumadin requires watching vitamin K, Grapefruit interacts with many heart medications, some diabetes medications increase heart risks, some heart medications increase risk for diabetes. Now we have a another  to be concerned about. Here is a new advisory the combination of NSAIDS and hypertensive drugs. This is challenging as we encourage patients to exercise and often there are side effects of sore muscles and joints. Based on this the recommendation for sore muscles and joints should be to use  ice and stretch…avoid the Motrin, Advil, Ibuprofin, Moabic, etc. The other challenge is to get the orthopedic physician and the cardiologist to work together to prescribe the safest medication regiment for you. Most importantly do not stop your anti-hypertensive medications without first consulting your physician, sudden withdrawal can be very problematic.

Adding a non-steroidal anti-inflammatory drug (NSAID) to dual antihypert ensive therapy (a diuretic plus either an ACE inhibitor or an angiotensin receptor blocker) is associated with an increase in risk for kidney injury, according to a large new retrospective study published inBMJ.

Adding a non-steroidal anti-inflammatory drug (NSAID) to dual antihypertensive therapy (a diuretic plus either an ACE inhibitor or an angiotensin receptor blocker) is associated with an increase in risk for kidney injury, according to a large new retrospective study published in BMJ.

Analyzing data from nearly half a million people taking antihypertensive drugs, researchers found 2,215 cases of acute kidney injury after a mean followup of 5.9 years. People on dual therapy were not at increased risk for acute kidney injury. However, when NSAID use was added to dual therapy, there was a modest but significant increase in risk (rate ratio 1.31, CI 1.12- 1.53). The increase in risk was highest in the first month of treatment.

The authors concluded that “increased vigilance may be warranted when” NSAIDs are used with dual antihypertensive therapy, especially in the early treatment period.

In an accompanying editorial, Dorothea Nitsch and Laurie A Tomlinson write that the safety of dual therapy still remains to be demonstrated and that the study likely “underestimates the true burden of drug associated acute kidney injury” in patients taking antihypertensive therapy and NSAIDs. Physicians should inform patients taking antihypertensive therapy about the possible risks of NSAID use and should ”be vigilant for signs of drug associated acute kidney injury in all patients.”

Here is the BMJ press release:

Triple mix of blood pressure drugs and painkillers linked to kidney problems

Absolute risk still low, but doctors and patients should be vigilant

Research: Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study

Editorial: Safety of co-prescribing NSAIDs with multiple antihypertensive agents

Patients who take a triple combination of blood pressure drugs and common painkillers are at an increased risk of serious kidney problems, especially at the start of treatment, finds a study published on bmj.com today.

Although the absolute risk for individuals is low, it is still something doctors and patients should be aware of, say the researchers.

Acute kidney injury (also known as kidney failure) is a major public health concern. It occurs in more than 20% of hospital inpatients and is associated with around half of all potentially preventable deaths in hospital. It is often triggered by adverse reactions to drugs, but little is known about the safety of different drug combinations.

So a team of researchers from the Jewish General Hospital and McGill University in Montreal, Canada, set out to assess whether certain combinations of drugs to lower blood pressure (antihypertensive drugs) and non-steroidal anti-inflammatory drugs (NSAIDs) are linked to an increased risk of kidney injury.

These drugs are commonly prescribed together, particularly in elderly people with several long term conditions.

Using the world’s largest computerised database of primary care records (CPRD), they identified 487,372 people who received antihypertensive drugs between 1997 and 2008. Drugs included angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and diuretics, with NSAIDs.

Patients were tracked for nearly six years, during which time 2,215 were diagnosed with acute kidney injury that prompted admission to hospital or dialysis (7 in 10,000 person years).

The results show that patients taking a double therapy combination of either a diuretic or an ACE inhibitors or ARB with an NSAID were at no increased risk of kidney injury. However, a triple therapy combination of a diuretic with an ACE inhibitor or ARB and an NSAID was associated with a 31% higher rate of kidney injury, particularly elevated in the first 30 days of treatment during which it was 82% higher.

These results remained consistent after adjusting for confounding factors and controlling for other potential sources of bias.

The authors conclude that, “although antihypertensive drugs have cardiovascular benefits, vigilance may be warranted when they are used concurrently with NSAIDs.” They add: “In particular, major attention should be paid early in the course of treatment, and a more appropriate choice among the available anti-inflammatory or analgesic drugs could therefore be applied in clinical practice.”

In an accompanying editorial, researchers at the London School of Hygiene and Tropical Medicine say this study “is an important step in the right direction” but “probably underestimates the true burden of drug associated acute kidney injury.”

They suggest that clinicians advise patients of the risks and be vigilant for drug associated acute kidney injury, and say “the jury is still out on whether double drug combinations are indeed safe.”

Acute Kidney Injury Associated With Dual Antihypertensive Therapy And NSAIDs