Moderate
Bisoprolol × Diclofenac
Selective beta-adrenergic blockers×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
NSAIDs weaken the antihypertensive effect of beta-blockers via renal prostaglandin suppression. Diclofenac is one of the most ulcerogenic NSAIDs with elevated cardiovascular risk.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
Avoid prolonged diclofenac use. For acute pain: short course (5–7 days) with pantoprazole cover. For chronic analgesia: paracetamol, celecoxib, or topical NSAIDs.