NSAID Use in Early Axial Spondyloarthritis Not Linked to Hypertension: Study

A study published in the journal of Joint Bone Spine has revealed that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) was not associated with an increased risk of developing hypertension in younger patients with early axial spondyloarthritis (axSpA). The findings suggest that NSAID therapy may have a favorable cardiovascular safety profile in patients with early-stage disease.

This research analyzed data from the French DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR) cohort, which tracked individuals with recent-onset axSpA. NSAIDs are widely prescribed as a first-line treatment for axSpA due to their effectiveness in reducing inflammation, pain, and stiffness. However, concerns have persisted regarding their potential cardiovascular side effects, particularly the risk of elevated blood pressure.

This study included 631 patients who had recently developed axSpA and did not have hypertension at the start of the study. The participants with an average age of 33 years, who were women accounted for 54% of the cohort. This study followed patients for up to 10 years, with clinical assessments conducted every 6 months during the first two years and annually thereafter.

NSAID exposure was measured using the Assessment of SpondyloArthritis International Society (ASAS) NSAID index, which quantifies both dosage and duration of use. High-dose NSAID use was defined as an ASAS index score of 50 or greater. At baseline, nearly 40% of participants were classified as high-dose users.

During the follow-up period, 88 patients developed hypertension. Hypertension was identified through self-reported diagnoses, use of antihypertensive medications, or repeated blood pressure measurements showing systolic readings of at least 140 mmHg or diastolic readings of at least 90 mmHg.

After accounting for changing NSAID exposure over time, as well as demographic and clinical factors such as disease activity and concurrent medication use, this study found no meaningful relationship between NSAID use and incident hypertension. The primary analysis yielded a hazard ratio of 1.01, which indicated no statistically significant increase in risk. Similar results were observed across multiple methods of measuring NSAID exposure.

The findings challenge longstanding concerns that chronic NSAID therapy may substantially contribute to hypertension in younger axSpA populations.

Overall, the findings of this research observed that while cardiovascular monitoring remains important, their results suggest that NSAID treatment itself may not be a major driver of hypertension development in these patients. Further studies in other populations are needed to confirm these findings.

Source:

Meade-Aguilar, J. A., Stovall, R., Ramiro, S., Tournadre, A., Molto, A., Courties, A., Gensler, L. S., & Liew, J. W. (2026). Nonsteroidal anti-inflammatory drug use and incident hypertension in axial spondyloarthritis: Data from DESIR cohort. Joint, Bone, Spine: Revue Du Rhumatisme, 93(4), 106059. https://doi.org/10.1016/j.jbspin.2026.106059