This patient has uncontrolled hypertension despite an appropriate 2-drug regimen. However, her blood pressure had been under control prior to starting the nonsteroidal anti-inflammatory drug (NSAID) naproxen for osteoarthritis. Commonly used medications that can raise blood pressure include:
NSAIDs likely raise blood pressure due to decreased renal clearance of sodium. Dietary sodium restriction may reduce the hypertensive effect of NSAIDs, but many patients will need to discontinue NSAIDs. High-dose acetaminophen (>3 g/day) may also raise blood pressure, but the effect at lower doses appears to be minimal. Acetaminophen may therefore be an acceptable alternative to NSAIDs for patients with hypertension.
