Friday, January 11, 2013


Dr Francesco Lapi and colleagues from the Jewish General Hospital, Montreal, published their findings on this subject in the Jan 8th online edition of the British Medical Journal. They studied the records ( retrospective ) from the UK Clinical Research Datalink ( a very large database ) of patients on treatment with dual anti-hypertensive therapy ( a diuretic + an ACE-I or ARB ) and correlated these patients outcome with the Hospital Episodes Statistics. They reviewed the records from 1997-2008, found the patients and followed them up ( from the records ) for 6 years.
All in all there were 487,372 patients who fulfilled the criteria. They found that dual anti-hypertensive therapy was not co-related with acute Renal injury. But the addition of an NSAID for was associated with an 80% increase incidents of acute renal injury, especially in the first 30 days.
I think this study is important because of the sheer size of the population at risk. It is quite comment for me to use a diuretic + a ACE-I or ARB to try and control BP. Infact, there are many companies with a ACE-I + HCT combination, or ARB + HCT combination. In these hypertensive population, it is not uncommon for the patients to have some joint or bone pains for which we may prescribe an NSAID. The authors advise that when met with such a situation, choose the analgesic carefully, and be aware that the triple combination may harm the kidneys. It should not be prescribed carelessly. An 80% increase risk is alot, and acute renal injury does carry a significant mortality and morbidity.
So in hypertensives on dual anti-hypertensive therapy, when you are considering using a analgesic, a red flag should appear, and we should choose the analgesic with care.

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