STUDIES SHOW OTC PAIN KILLERS POSE HYPERTENSION RISK

Nonsteroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, increase the risk of heart attack and stroke, the American Heart Association (AHA) said, recommending that these drugs not be used as the first line of treatment for patients at risk for heart disease.

In addition, a separate study in the Feb. 26 issue of Archives of Internal Medicine found an independent association between the frequency of analgesic use and risk of hypertension. It noted that non-narcotic analgesics, including acetaminophen, ibuprofen and aspirin, are the most commonly used drugs in the U.S.

"Many doctors should change the way they prescribe pain relievers," the AHA said. "For chronic pain in patients with known heart disease, or who are at risk for heart disease, these drugs should be the last line of treatment," Elliott Antman, lead author of the AHA statement and professor of medicine at Harvard, said.

Multiple studies have shown an increased risk of heart disease from Cox-2 selective NSAIDs, the AHA said, particularly in patients with prior cardiovascular disease or risk factors.

The association suggested that physicians begin pain treatment with non-pharmaceutical options such as physical therapy, exercise, weight loss and heat therapy. If this approach is insufficient, doctors should use a "stepped-care" system for prescribing drugs, the AHA said. The patient's health history should be factored in, and aspirin, acetaminophen or even short-term use of narcotic analgesics should be considered first. If a next step is necessary, doctors should suggest the least selective Cox-2 inhibitor, moving toward more selective Cox-2 inhibitors only as needed.