Knowledge, attitudes, and practices regarding NSAID use and associated cardiovascular and renal risks among adults with hypertension in the West Bank, Palestine: a multicenter cross-sectional study
This multicenter cross-sectional study in the West Bank reveals that while NSAID use is common among adults with hypertension, awareness of associated cardiovascular and renal risks is limited, with nonprescription acquisition and lower educational attainment significantly linked to poorer knowledge and unsafe practices.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Painkillers are among the most common medicines in the world, used by millions to soothe headaches, joint pain, and fevers. For many, these drugs are a reliable tool for daily life, often available without a doctor's note. However, for people with high blood pressure, these same medicines can create a hidden conflict. While they relieve pain, they can also make blood pressure harder to control and strain the kidneys, which act as the body's filters. This is not a rare edge case; it is a significant medical reality where a common remedy can worsen a chronic condition. The challenge lies in the fact that many people with high blood pressure do not realize these risks, or they assume that because a medicine is easy to buy, it is safe for everyone. Understanding how patients think about these drugs, and how they actually use them, is essential for keeping them safe.
In the West Bank, a team of researchers set out to explore this exact gap between what people know and what they do. They focused on adults living with high blood pressure, visiting hospitals and primary care centers across the region to ask a simple but critical question: Do these patients understand the dangers of taking nonsteroidal anti-inflammatory drugs, and are they using them safely? The study involved 384 adults, a group that represented a mix of ages, education levels, and years living with high blood pressure. The researchers did not just ask if people took these drugs; they asked how they got them, why they took them, and what they believed about the risks to their hearts and kidneys.
The results revealed a picture of widespread use mixed with significant gaps in understanding. Nearly two-thirds of the participants had taken these painkillers within the last three months. For many, the reason was straightforward: joint or back pain, which is the most common reason people reach for these medicines. However, a troubling pattern emerged regarding how they obtained the drugs. Among those who had used them recently, almost half did so without a doctor's prescription, buying them directly from a pharmacy or using them based on their own judgment. This self-directed use is a major concern because it bypasses the medical advice that could warn a patient with high blood pressure about the specific dangers these drugs pose to their condition.
When the researchers tested what the participants actually knew, the findings were uneven. Most people were aware that long-term use of these painkillers could hurt the kidneys. More than three-quarters recognized that the drugs might impair kidney function. Yet, knowledge about the connection to blood pressure and the heart was much weaker. Less than half of the participants knew that these drugs could raise blood pressure, and only about a quarter understood that they could increase the risk of heart problems for people who already have high blood pressure or heart disease. A common misconception also surfaced: more than half of the group believed that because these drugs are available without a prescription, they are safe for everyone. This belief persists despite the fact that the drugs are known to interfere with blood pressure medications and strain the heart.
The study also looked at the relationship between what people said they believed and how they actually behaved. The researchers found a surprising disconnect. People who expressed the most cautious attitudes—saying they were very careful and worried about safety—were not necessarily the ones who acted the most safely. In fact, those who scored highest on a scale of "cautious beliefs" were often the least likely to follow safe practices in reality. This suggests that simply worrying about a risk does not always translate into changing one's behavior. Instead, the factors that truly predicted safer behavior were more practical. People who had been diagnosed with high blood pressure for a longer time, those with higher levels of education, and those who obtained their painkillers through a doctor's prescription were the ones most likely to use the drugs safely.
The researchers noted that the way people got their medicine mattered more than their general worry level. Those who received a prescription from a doctor were more likely to know the risks and to use the drugs in a safer manner. This points to the doctor's role not just as a prescriber, but as a teacher. When a doctor hands over a prescription, they have a chance to explain the specific dangers for that patient. In contrast, buying the drug over the counter often means missing that crucial conversation. The study also found that people with kidney disease were more likely to use the drugs safely, likely because they are under closer medical supervision, even though they did not necessarily express more fear or caution in their answers.
Ultimately, the study highlights that the path to safety for people with high blood pressure is not just about knowing the facts, but about how they access their medicine. The most effective way to ensure safety appears to be through the guidance of a healthcare professional. The researchers concluded that doctors and pharmacists have a vital opportunity to step in, asking patients about their use of over-the-counter painkillers and offering clear, targeted advice about the risks to their blood pressure and kidneys. While the study could not prove that one thing caused the other due to its design, the patterns were clear: better education and a direct connection to a doctor were linked to safer habits. The findings suggest that to protect the health of people with high blood pressure, the focus must shift from simply hoping patients are careful to actively ensuring they have the right information and the right support when they reach for a painkiller.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.