Intended for healthcare professionals


Safety of coprescribing NSAIDs with multiple antihypertensive agents

BMJ 2013; 346 doi: (Published 08 January 2013) Cite this as: BMJ 2013;346:e8713
  1. Dorothea Nitsch, clinical senior lecturer,
  2. Laurie A Tomlinson, honorary research fellow
  1. 1Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. dorothea.nitsch{at}

Triple drug combinations are associated with increased hospital admission for acute kidney injury, but questions remain

Current guidelines by the National Institute for Health and Clinical Excellence (NICE) recommend treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for conditions such as hypertension,1 chronic heart failure,2 and proteinuric chronic kidney disease.3 In England, the prescription of these drugs has increased by 15.8% over the past four years.4 Because ACE inhibitors and ARBs are often coprescribed with non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, particularly in older people,5 we need to know more about the safety of such combinations.

In a linked paper (doi:10.1136/bmj.e8525), Lapi and colleagues used a large database that was representative of UK primary care to examine data on 487 372 patients taking antihypertensive drugs.6 They used a nested case-control design to examine whether adding an NSAID to an ACE inhibitor, ARB, or diuretic in double or triple therapy combinations increased the risk of subsequent hospital admission with acute kidney injury. Acute kidney injury is seen in more than …

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