If you have ankylosing spondylitis (AS) — an inflammatory form of arthritis that causes chronic lower back pain — it makes sense that you’d frequently reach for an NSAID (non-steroidal anti-inflammatory drug) like ibuprofen or naproxen. Your doctor might have even given you a prescription for another drug in this class, like indomethacin (Indocin), and told you to take it daily or several times a day. In fact, NSAIDs are considered a first-line treatment for ankylosing spondylitis and axial spondyloarthritis. While these drugs can fight inflammation and help keep you comfortable, they also have downsides.

Many people who use over-the-counter (OTC) NSAIDs don’t notice any side effects, and when they do mild stomach upset is most common. But both prescription and over-the-counter NSAIDs can also increase your risk of ulcers, kidney disease, and heart disease: In 2015, the FDA warned that non-aspirin NSAIDs may increase the risk of heart attack and stroke.

Part of these cardiac and kidney risks stem from the fact that NSAIDs can raise your blood pressure, and as with other possible side effects, the risk of this happening increases with higher doses and longer-term use. So perhaps it’s not surprising that a new study focusing on AS patients found that those who take high doses of NSAIDs or use these drugs continuously are more apt to have high blood pressure.

The study, which was published in the journal Arthritis Care & Research, followed 628 AS patients. At the beginning of study none had hypertension, but over the next seven years 129 developed it. The authors determined that those who had used NSAIDs continuously were about 12 percent more likely to have developed high blood pressure compared to those who rarely used them.

Older age and obesity were also associated with a higher risk of hypertension, but AS disease activity, sex, and race did not seem to have an impact.

Although these findings were not unexpected, they are problematic in light of the fact that people with AS (and other forms of inflammatory arthritis) already have a higher than average risk for cardiovascular disease.

In light of the fact that NSAIDs are often the first-line treatment for AS, “current guidelines do not specifically address the prevention or management of [cardiovascular disease] in individuals with AS,” the authors wrote. “There is an unmet need to clarify how treatment choices, particularly the use of NSAIDs… impact CV [cardiovascular disease] risk factors and CV events in AS.”

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