Moderate
Bisoprolol × naproxen
Selective beta-adrenergic blockers×NSAID, propionic acid derivative
Mechanism
NSAIDs weaken the antihypertensive effect of beta-blockers via renal prostaglandin suppression.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
For short naproxen courses (5–7 days), monitor blood pressure. For chronic analgesia: switch to paracetamol or celecoxib (with PPI cover).