Moderate
Established
Açıklama
NSAIDs reduce the antihypertensive and renoprotective efficacy of ACE inhibitors and can precipitate acute kidney injury, particularly in volume-depleted or elderly patients.
Mekanizma
Ibuprofen inhibits renal prostaglandin synthesis, causing afferent arteriolar vasoconstriction and sodium retention; this blunts ACE-inhibitor-mediated vasodilation and reduces GFR.
Klinik Önemi
Blood pressure may rise 3–5 mmHg on average; in high-risk patients (HF, CKD, dehydration), acute kidney injury and hyperkalemia can occur.
Yönetim
Avoid chronic NSAID use in ACE inhibitor-treated patients; monitor serum creatinine and potassium within 1–2 weeks of initiating NSAID. Prefer acetaminophen for analgesia.