Treatment of Hypertension and Osteoarthritis: A Medication Plan, Case Study Example

The treatment of hypertension with ACE inhibitors, when combined with medications to treat osteoarthritis, can be problematic because many of the pain medications interfere with the effectiveness of the blood pressure medication and additionally present other potential medical issues, such as renal deterioration or failure (NSAIDs, 2011.). In addition, they can cause stomach problems including bleeding ulcers. Such a dilemma occurs in the case history presented, because the patient has a family history of cardiovascular dysfunction as well as high blood pressure, and has recently been diagnosed with osteoarthritis. The need for pain medication is pressing, because his occupation presents factors that increase his arthritic pain, so that the challenge for his medical providers are to manage that pain while preventing his blood pressure medication, lisinopril, from being compromised. This paper will discuss which pain medication would be optimal for him in order to sustain control of his hypertension.

Non-steroidal anti-inflammatory drugs have been the cornerstone of managing pain from osteoarthritis and other conditions; however there is controversy surrounding the cardiovascular safety of cyclo-oxygenase-2 selective inhibitors, with related apprehension about traditional NSAIDs (Trelle, 2010.) However, although certain NSAIDs may increase blood pressure, they range in their tendency to have an impact on hypertensive medications (Pavlicevi?, 2008.) If the patient did not have significant risk for arthritic pain based on his job, i.e., standing for much of the day, the least dramatic treatment for his condition would be Tylenol, since the concerns about drug interactions with lisinopril are less with that over-the-counter drug. However, given the likely severity of the pain, it is necessary to treat this patient with a more potent medication, while taking precautions to minimize cardiovascular and gastrointestinal risks.

In a study of seven NSAIDs and their impact on hypertensive medications, naproxen seemed least harmful for cardiovascular safety (Trelle, 2010.) The study evaluated the cardiovascular safety of NSAIDs by taking into account incidence of fatal or nonfatal myocardial infarction, as well as fatal or non-fatal stroke, death caused by cardiovascular issues, as well is death from any other source. The study found that although all NSAIDs are associated with an increased risk of cardiovascular incidents, naproxen appeared to be the least harmful to patients. In order to adequately manage the pain for this patient, the use of naproxen is recommended, although patients receiving ACE inhibitors such as lisinopril who require prolonged (greater than one week) simultaneous treatment with NSAIDs should have close monitoring. This should include blood pressure followed more closely following initiation, discontinuation, or change of dosage of the NSAID; renal function should also be evaluated periodically during prolonged co-administration (Drug Interactions between Lisinopril and Motrin.)

In addition to the above-mentioned concerns about naproxen and other NSAIDs, the issue of gastrointestinal distress cannot be ignored. NSAIDs can have an extremely positive effect on pain, but they also risk creating stomach upset and bleeding ulcers (Avoiding Stomach Problems with NSAIDs, 2013.) There are certain precautions that can be taken, however, to minimize such risks, including avoiding alcohol, taking the medication with food and water, making sure not to take the medication more frequently than prescribed, or taking an anti-acid drug such as Prevacid along with the naproxen. These measures when practiced in combination should be able to reduce the threat of stomach problems while taking any of the NSAIDs. If the patient is unable to pay for the medication, he can contact the pharmaceutical company that manufactures naproxen to see whether they had a financial assistance program for patients with no prescription coverage.

Prescription: Naprosyn, 500 mg, BID, take with food.

References:

Avoiding Stomach Problems with NSAIDs. (2013). Retrieved February 10, 2013, from Arthritis Today: http://www.arthritistoday.org/treatments/drug-guide/drug-news-and-updates/analgesics–nsaids/nsaids-stomach-upset.php

Drug Interactions between Lisinopril and Motrin. (n.d.). Retrieved February 10, 2013, from Drugs.com: http://www.drugs.com/drug-interactions/lisinopril-with-motrin-1476-0-1310-780.html

NSAIDs. (2011, August). Retrieved February 10, 2013, from FDA.gov: http://www.fda.gov/Safety/MedWatch/SafetyInformation/ucm270998.htm

Pavlicevi? I, Kuzmani? M, Rumboldt M, & Rumboldt Z. (2008). Interaction between Antihypertensives and NSAIDs in Primary Care: a Controlled Trial. Canadian Journal of Clinical Pharmacology, 372-382.

Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, Egger M, & Jüni P.(2010, October 8). Cardiovascular Safety of Non-Steroidal Anti-Inflammatory Drugs: Network Meta-Analysis. Retrieved February 10, 2013, from BMJ: http://www.bmj.com/content/342/bmj.c7086