Skip to main content
NCBI home page
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1986 Apr;21(4):417–423. doi: 10.1111/j.1365-2125.1986.tb05216.x

The effects of sulindac and indomethacin on the anti-hypertensive and diuretic action of hydrochlorothiazide in patients with mild to moderate essential hypertension.

P P Koopmans, T Thien, C M Thomas, R J Van den Berg, F W Gribnau
PMCID: PMC1400929  PMID: 3518773

Abstract

In this double-blind two period crossover study, we investigated the effect of indomethacin and sulindac on blood pressure in 25 hypertensive patients being treated with hydrochlorothiazide. The study consisted of seven 4 week periods. In the first and the last period the patients took placebos, in period two, four and six they were treated with hydrochlorothiazide 50 mg once daily alone, and in the third and fifth period hydrochlorothiazide 50 mg once daily was given in combination with either indomethacin 50 mg twice daily or sulindac 200 mg twice daily in double-blind random order. Blood pressure, measured by sphygmomanometer and arteriosonde, and body weight were determined every 2 weeks. Compared with placebo hydrochlorothiazide decreased the mean arterial pressure by 8%. Addition of both indomethacin and sulindac resulted in only slight and generally similar changes of this blood pressure lowering effect. This was found both for the whole group and when both treatment sequence groups were analysed separately. In contrast to sulindac, indomethacin attenuated the hydrochlorothiazide-induced decreases of body weight, plasma potassium and the increase of plasma renin activity. Both non-steroidal anti-inflammatory drugs (NSAID) reduced the 24 h urinary excretion of prostaglandins (PGs), i.e. PGF2 alpha, 6 ketoPGF1 alpha and thromboxane B2 except PGE2. From this study it can be concluded that, in contrast to sulindac, indomethacin attenuated the diuretic action of hydrochlorothiazide, however apparently without consequences for its long-term blood pressure lowering effect. This study does not support the hypothesis that the difference between the two NSAIDs can be explained by different effects on renal PG synthesis.

Full text

PDF
417

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ciabattoni G., Cinotti G. A., Pierucci A., Simonetti B. M., Manzi M., Pugliese F., Barsotti P., Pecci G., Taggi F., Patrono C. Effects of sulindac and ibuprofen in patients with chronic glomerular disease. Evidence for the dependence of renal function on prostacyclin. N Engl J Med. 1984 Feb 2;310(5):279–283. doi: 10.1056/NEJM198402023100502. [DOI] [PubMed] [Google Scholar]
  2. De Man A. J., Hofman J. A., Hendriks T., Rosmalen F. M., Ross H. A., Benraad T. J. A direct radio-immunoassay for aldosterone: significance of endogenous cortisol. Neth J Med. 1980;23(2):79–83. [PubMed] [Google Scholar]
  3. Donker A. J., Arisz L., Brentjens J. R., van der Hem G. K., Hollemans H. J. The effect of indomethacin on kidney function and plasma renin activity in man. Nephron. 1976;17(4):288–296. doi: 10.1159/000180733. [DOI] [PubMed] [Google Scholar]
  4. Drayer J. I., Benraad T. J. The reliability of the measurement of plasma renin activity by radioimmunoassay. Clin Chim Acta. 1975 Jun 20;61(3):309–324. doi: 10.1016/0009-8981(75)90421-0. [DOI] [PubMed] [Google Scholar]
  5. Dunn M. J. Nonsteroidal antiinflammatory drugs and renal function. Annu Rev Med. 1984;35:411–428. doi: 10.1146/annurev.me.35.020184.002211. [DOI] [PubMed] [Google Scholar]
  6. Dunn M. J., Zambraski E. J. Renal effects of drugs that inhibit prostaglandin synthesis. Kidney Int. 1980 Nov;18(5):609–622. doi: 10.1038/ki.1980.179. [DOI] [PubMed] [Google Scholar]
  7. Freeman R. H., Davis J. O., Villarreal D. Role of renal prostaglandins in the control of renin release. Circ Res. 1984 Jan;54(1):1–9. doi: 10.1161/01.res.54.1.1. [DOI] [PubMed] [Google Scholar]
  8. Frölich J. C., Wilson T. W., Sweetman B. J., Smigel M., Nies A. S., Carr K., Watson J. T., Oates J. A. Urinary prostaglandins. Identification and origin. J Clin Invest. 1975 Apr;55(4):763–770. doi: 10.1172/JCI107987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Koopmans P. P., Thien T., Gribnau F. W. Influence of non-steroidal anti-inflammatory drugs on diuretic treatment of mild to moderate essential hypertension. Br Med J (Clin Res Ed) 1984 Dec 1;289(6457):1492–1494. doi: 10.1136/bmj.289.6457.1492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Levenson D. J., Simmons C. E., Jr, Brenner B. M. Arachidonic acid metabolism, prostaglandins and the kidney. Am J Med. 1982 Feb;72(2):354–374. doi: 10.1016/0002-9343(82)90826-9. [DOI] [PubMed] [Google Scholar]
  11. Lifschitz M. D. Renal effects of nonsteroidal anti-inflammatory agents. J Lab Clin Med. 1983 Sep;102(3):313–323. [PubMed] [Google Scholar]
  12. Lopez-Ovejero J. A., Weber M. A., Drayer J. I., Sealey J. E., Laragh J. H. Effects of indomethacin alone and during diuretic or beta-adrenoreceptor-blockade therapy on blood pressure and the renin system in essential hypertension. Clin Sci Mol Med Suppl. 1978 Dec;4:203s–205s. doi: 10.1042/cs055203s. [DOI] [PubMed] [Google Scholar]
  13. McGiff J. C. Prostaglandins, prostacyclin, and thromboxanes. Annu Rev Pharmacol Toxicol. 1981;21:479–509. doi: 10.1146/annurev.pa.21.040181.002403. [DOI] [PubMed] [Google Scholar]
  14. Salvetti A., Arzilli F., Pedrinelli R., Beggi P., Motolese M. Interaction between oxprenolol and indomethacin on blood pressure in essential hypertensive patients. Eur J Clin Pharmacol. 1982;22(3):197–201. doi: 10.1007/BF00545214. [DOI] [PubMed] [Google Scholar]
  15. Sedor J. R., Williams S. L., Chremos A. N., Johnson C. L., Dunn M. J. Effects of sulindac and indomethacin on renal prostaglandin synthesis. Clin Pharmacol Ther. 1984 Jul;36(1):85–91. doi: 10.1038/clpt.1984.144. [DOI] [PubMed] [Google Scholar]
  16. Steiness E., Waldorff S. Different interactions of indomethacin and sulindac with thiazides in hypertension. Br Med J (Clin Res Ed) 1982 Dec 11;285(6356):1702–1703. doi: 10.1136/bmj.285.6356.1702-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Tan S. Y., Mulrow P. J. Inhibition of the renin-aldosterone response to furosemide by indomethacin. J Clin Endocrinol Metab. 1977 Jul;45(1):174–176. doi: 10.1210/jcem-45-1-174. [DOI] [PubMed] [Google Scholar]
  18. Thomas C. M., van den Berg R. J., de Koning Gans H. J., Leguin R. M. Radioimmunoassays for prostaglandins. I. Technical validation of prostaglandin F2alpha measurements in human plasma using sephadex G-25 gelfiltration. Prostaglandins. 1978 May;15(5):839–847. doi: 10.1016/0090-6980(78)90150-8. [DOI] [PubMed] [Google Scholar]
  19. Thomas C. M., van den Berg R. J., de Koning Gans H. J., Lequin R. M. Radioimmunoassays for prostaglandins. II. Measurement of prostaglandin E2 and the 13,14-dihydro-15-keto metabolites of the E and F series. Description of a reliable technique with a universal applicability. Prostaglandins. 1978 May;15(5):849–855. doi: 10.1016/0090-6980(78)90151-x. [DOI] [PubMed] [Google Scholar]
  20. Watkins J., Abbott E. C., Hensby C. N., Webster J., Dollery C. T. Attenuation of hypotensive effect of propranolol and thiazide diuretics by indomethacin. Br Med J. 1980 Sep 13;281(6242):702–705. doi: 10.1136/bmj.281.6242.702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wing L. M., Bune A. J., Chalmers J. P., Graham J. R., West M. J. The effects of indomethacin in treated hypertensive patients. Clin Exp Pharmacol Physiol. 1981 Sep-Oct;8(5):537–541. doi: 10.1111/j.1440-1681.1981.tb00763.x. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES