FRI0317 Nsaids in Ambulatory and Hospital Patients with Gout: Hypertensive Reaction
Authors: E. Mikhnevich, T. Pavlovich
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Today, the cardiovascular side effects of non-steroidal anti-inflammatory drugs (NSAIDs) are known to attract more attention than the gastro-intestinal ones, with the destabilization of hypertension (HTN) being the most common among them. <h3>Objectives</h3> To compare the levels of destabilization of HTN in patients with gouty arthritis (GA) receiving NSAIDs in ambulatory and hospital settings; to study factors contributing to the destabilization of HTN during hospitalisation period. <h3>Methods</h3> 207 patients with GA were selected for the study. The diagnosis was based on the GA criteria (ACR, 1977). 88.9% of patients were males. The mean age was 57±9.9 years, the average duration of disease was 7.79±6.7 year s. NSAIDs were administered to the same patients in ambulatory and hospital settings. 48.8% (n=101) of ambulatory and 70% (n=145) of hospital patients received high doses of NSAIDs. Destabilized HTN was defined as sitting blood pressure (BP) ≥140/90 mm Hg and ≥150/90 mm Hg for patients aged ≥60 years. Ambulatory BP was checked at every visit; at the hospital, BP was measured on the first day of admission every 3 hours, if necessary, it was corrected, if increased, the 24h monitoring of BP was carried out. 28.5% (n=53) of patients had no pre-existing HTN or any antihypertensive drugs, and 71.5% (n=154) of patients suffered from HTN of various duration and severity. <h3>Results</h3> Among ambulatory patients without HTN (HTN-), 28.3% (n=15) had elevated BP during the treatment period. Of 154 patients with GA and concomitant HTN (HTN+), increased BP was evidenced in 64.3% (n=99). During the hospitalization, 18.9% (n=10) of HTN- patients presented with hypertensive reaction, thus, the number of new cases in outpatients was 5.7% (n=3). Among HTN+ patients, an elevated BP was observed in 40.25% (n=62), including 13% (n=20) new cases. In 55.1% (n=114) of ambulatory patients, we observed unstable BP during the period of treatment with NSAIDs, while in the group of hospitalized patients, unstable HTN was reported in 34.8% (n=72). The difference between the number of patients with destabilized HTN in ambulatory and hospital settings was statistically significant (χ2 =17.22; p&lt;0.0001). The total number of patients with elevated BP made 66.2% (n=137) during both phases of treatment with NSAIDs. Only 55 HTN+ patients had stable BP during the ambulatory phase, but at a hospital setting, 20 of them developed elevated BP. It is worth to note that we found the only difference between the two groups: patients with destabilized HTN had more frequent hyperuricemia at the period of hospitalisation. (OR-5.32; 95%CI 1.4–20.2; p&lt;0.05). <h3>Conclusions</h3> There is a significant difference between the levels of destabilization of hypertension during the treatment with NSAIDs of patients with gouty attacks in ambulatory and hospital settings: 55.1% and 34.8%. This supposes that in ambulatory gouty patients under NSAIDs a careful control of their BP should be required, even with no history of pre-existing hypertension. In spite of a rational antihypertensive therapy instable BP among patients with gouty arthritis receiving NSAIDs may be connected to hyperuricemia. <h3>Disclosure of Interest</h3> None declared