Painkillers Worsen Heart Failure
Even Short-Term Ibuprofen, Naproxen May Put Heart Patients in Hospital
Blood Pressure Drugs
For people taking blood pressure drugs -- diuretics (water pills), ACE inhibitors, or beta-blockers -- there's an even greater risk. Even short-term use of NSAIDs boosts heart failure-related hospitalizations in these patients, the Huerta study shows.
Smith says the problem isn't that NSAIDs are directly toxic to the heart. But because of the way they work, they counteract the effects of blood pressure drugs. In patients whose lives depend on these drugs, the effects can be severe -- and sudden.
"In our clinic, we can see an immediate impact when an advanced heart failure patient takes an NSAID," Smith says. "One day their diuretic is working. The next day, fluid retention puts them in the hospital. It depends on the underlying heart disease whether the effect is this dramatic."
Ochsner Clinic cardiologist Homeyar Dinshaw, MD, tells patients who need an NSAID to keep a sharp lookout for telltale signs of water retention.
"Recently, I have started telling patients that if they take an NSAID, they should watch out for fluid retention," he says. "They do this by checking their weight at the same time every morning. And at other times, I have them check the skin just below the sock line. If you press over the bony surface just a bit above the ankle and get an indentation, you are retaining water."
Smith has a better idea. Heart patients who need painkillers, he says, should take acetaminophen -- Tylenol, for example -- instead of an NSAID.