There are limited data on how NSAID use and dosage influence hypertension risk in axial spondyloarthritis (axSpA). We evaluated the association between NSAID use and incident hypertension in a longitudinal axSpA inception cohort.

We analyzed data from the DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR) cohort, with visits every six months for two years, then annually up to 10 years. Hypertension was defined by self-report, antihypertensive medication use, and/or systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg on ≥ 2 visits. NSAID use over the prior six months was quantified using the ASAS NSAID index at each visit, categorized as high-dose (≥ 50) or low/no use. Cox proportional hazards models with time-varying NSAID exposure and confounder adjustment were used to study the relationship between NSAID use and incident hypertension.

We included 631 patients with recent onset axSpA without baseline hypertension (mean age 33 years, 54% female, 247 [39.1%] patients with high-dose NSAID use). Over 10-year follow-up, 88 developed incident hypertension. Multivariable models showed no significant association between NSAID use and incident hypertension (hazard ratio 1.01, 95% confidence interval 1.00–1.02, main analysis) across multiple exposure definitions after accounting for baseline and time-varying demographic and clinical covariates including disease activity and other medication use.

In this axSpA inception cohort, we found no significant association between NSAID use and the development of hypertension. These findings, if confirmed in other studies, can provide reassurance to prescribe NSAIDs, particularly in younger patients with axSpA.