Background Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications, but they are associated with a number of serious adverse effects, including hypertension, cardiovascular disease, kidney injury and GI complications. Objective To develop a set of multidisciplinary recommendations for the safe prescription of NSAIDs. Methods Randomised control trials and observational studies published before January 2018 were reviewed, with 329 papers included for the synthesis of evidence-based recommendations. Results Whenever possible, a NSAID should be avoided in patients with treatment-resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). Before treatment with a NSAID is started, blood pressure should be measured, unrecognised CKD should be screened in high risk cases, and unexplained iron-deficiency anaemia should be investigated. For patients with high cardiovascular risk, and if NSAID treatment cannot be avoided, naproxen or celecoxib are preferred. For patients with a moderate risk of peptic ulcer disease, monotherapy with a non-selective NSAID plus a proton pump inhibitor (PPI), or a selective cyclo-oxygenase-2 (COX-2) inhibitor should be used; for those with a high risk of peptic ulcer disease, a selective COX-2 inhibitor plus PPI are needed. For patients with pre-existing hypertension receiving renin-angiotensin system blockers, empirical addition (or increase in the dose) of an antihypertensive agent of a different class should be considered. Blood pressure and renal function should be monitored in most cases. Conclusion NSAIDs are a valuable armamentarium in clinical medicine, but appropriate recognition of high-risk cases, selection of a specific agent, choice of ulcer prophylaxis and monitoring after therapy are necessary to minimise the risk of adverse events.

中文翻译：

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高血压、心血管、肾脏或胃肠道合并症患者的非甾体抗炎药 (NSAID) 治疗：联合 APAGE/APLAR/APSDE/APSH/APSN/PoA 建议

背景 非甾体抗炎药 (NSAID) 是最常用的处方药之一，但它们会带来许多严重的不良反应，包括高血压、心血管疾病、肾损伤和胃肠道并发症。目的 制定一套安全处方 NSAID 的多学科建议。方法 回顾了 2018 年 1 月之前发表的随机对照试验和观察性研究，纳入了 329 篇论文用于综合循证建议。结果 在可能的情况下，对于难治性高血压、心血管疾病高风险和严重慢性肾病 (CKD) 的患者，应避免使用 NSAID。在开始使用 NSAID 治疗之前，应测量血压，在高危病例中应筛查未被识别的 CKD，应调查原因不明的缺铁性贫血。对于心血管风险高的患者，如果不能避免 NSAID 治疗，首选萘普生或塞来昔布。对于消化性溃疡病中等风险的患者，应使用非选择性 NSAID 加质子泵抑制剂 (PPI) 或选择性环氧化酶-2 (COX-2) 抑制剂单药治疗；对于消化性溃疡病高危人群，需要选择性COX-2抑制剂加PPI。对于接受肾素-血管紧张素系统阻滞剂的既往高血压患者，应考虑经验性添加（或增加剂量）不同类别的抗高血压药物。大多数情况下应监测血压和肾功能。结论 NSAIDs 是临床医学中的宝贵武器，