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Jerry H. Gurwitz, MD; Jerry Avorn, MD; Rhonda L. Bohn, MPH; Robert J. Glynn, PhD; Mark Monane, MD; Helen Mogun, MS

JAMA. 1994;272(10):781-786.

Abstract
Objective.
—To determine whether there is an increased risk for the initiation of antihypertensive therapy in older persons prescribed nonaspirin, nonsteroidal anti-inflammatory drugs (NSAIDs).

Design.
—Case-control study.

Setting.
—New Jersey Medicaid program.

Patients.
—Medicaid enrollees aged 65 years and older. The 9411 case patients were newly started on an antihypertensive medication between November 1981 and February 1990. A similar number of controls were randomly selected among other enrollees.

Main Outcome Measures.
—We used logistic regression to determine the odds ratio for the initiation of antihypertensive therapy in patients using NSAIDs relative to nonusers, after adjusting for age, sex, race, nursing home residence, number of prescriptions filled, intensity of physician utilization, and days hospitalized.

Results.
—The adjusted odds ratio for the initiation of antihypertensive therapy for recent NSAID users compared with nonusers was 1.66 (95% confidence interval, 1.54 to 1.80). The odds ratio increased with increasing daily NSAID dose: the adjusted odds ratio for users of low average daily doses relative to nonusers was 1.55 (95% CI, 1.38 to 1.74), that for medium-dose users was 1.64 (95% CI, 1.44 to 1.87), and that for high-dose users was 1.82 (95% CI, 1.62 to 2.05).

Conclusions.
—Use of NSAIDs may increase the risk for initiation of antihypertensive therapy in older persons. Given the high prevalence of NSAID use by elderly persons, this association may have important public health implications for the management of hypertension in the older population.

(JAMA. 1994;272:781-786)

Author Affiliations
From the Program for the Analysis of Clinical Strategies (Drs Gurwitz, Avorn, Glynn, and Monane and Mss Bohn and Mogun), the Divisions of Gerontology (Drs Gurwitz, Avorn, and Monane and Mss Bohn and Mogun) and Preventive Medicine (Dr Glynn), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, and the Brockton/West Roxbury (Mass) Veterans Affairs Medical Center (Dr Gurwitz).

Footnotes
Reprint requests to Program for the Analysis of Clinical Strategies, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115 (Dr Gurwitz).

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