Comparison of Changes in Blood Pressure Measurements and Antihypertensive Therapy in Older, Hypertensive, Ambulatory Care Patients Prescribed Celecoxib or Rofecoxib

Nietert, Paul J.; Ornstein, Steven M.; Dickerson, Lori M.; Rothenberg, Ralph J.

doi:10.1592/phco.23.14.1416.31935

Cited by 17 publications

(7 citation statements)

References 32 publications

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“…Another analysis was conducted to investigate whether the increase in systolic blood pressure associated with NSAIDs is clinically important. A clinically important increase was defined as systolic blood pressure increase from baseline by at least 20 mmHg since the risk of mortality doubles for such an increase [2,33]. …”

Section: Methodsmentioning

confidence: 99%

Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension

Aljadhey

Hansen

et al. 2012

BMC Cardiovasc Disord

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BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) may disrupt control of blood pressure in hypertensive patients and increase their risk of morbidity, mortality, and the costs of care. The objective of this study was to examine the association between incident use of NSAIDs and blood pressure in patients with hypertension.MethodsWe conducted a retrospective cohort study of adult hypertensive patients to determine the effects of their first prescription for NSAID on systolic blood pressure and antihypertensive drug intensification. Data were collected from an electronic medical record serving an academic general medicine practice in Indianapolis, Indiana, USA. Using propensity scores to minimize bias, we matched a cohort of 1,340 users of NSAIDs with 1,340 users of acetaminophen. Propensity score models included covariates likely to affect blood pressure or the use of NSAIDs. The study outcomes were the mean systolic blood pressure measurement after starting NSAIDs and changes in antihypertensive therapy.ResultsCompared to patients using acetaminophen, NSAID users had a 2 mmHg increase in systolic blood pressure (95% CI, 0.7 to 3.3). Ibuprofen was associated with a 3 mmHg increase in systolic blood pressure compared to naproxen (95% CI, 0.5 to 4.6), and a 5 mmHg increase compared to celecoxib (95% CI, 0.4 to 10). The systolic blood pressure increase was 3 mmHg in a subgroup of patients concomitantly prescribed angiotensin converting enzyme inhibitors or calcium channel blockers and 6 mmHg among those prescribed a beta-adrenergic blocker. Blood pressure changes in patients prescribed diuretics or multiple antihypertensives were not statistically significant.ConclusionCompared to acetaminophen, incident use of NSAIDs, particularly ibuprofen, is associated with a small increase in systolic blood pressure in hypertensive patients. Effects in patients prescribed diuretics or multiple antihypertensives are negligible.

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Section: Methodsmentioning

confidence: 99%

Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension

Aljadhey

Hansen

et al. 2012

BMC Cardiovasc Disord

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“…When celecoxib 200 mg daily was compared with rofecoxib 25 mg daily for treatment of osteoarthritis in patients with hypertension, rofecoxib was associated with increased dosages of antihypertensive medications. 25 It is important to remember that COX-2 inhibitors do not offer any antiplatelet protection for those patients who also require such treatment. In addition, if COX-2 inhibitors are taken with low-dose aspirin, then any relative gastrointestinal symptom-sparing advantage of these drugs is lost.…”

Section: Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

Treatment of chronic pain in persons with dementia: An overview

Rubey

2005

Am J Alzheimers Dis Other Demen

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“…COX-2 inhibitors were reported to have adverse effects on blood pressure in stable hypertensive patients [110]. COX-2 inhibitors have been shown to cause sodium retention in a small percentage of patients without renal impairment [111] and the renal toxicity of COX-2 inhibitors is reported to be very similar to those of non-selective NSAIDs [112][113][114][115].…”

Section: Coxibs: Renal Effectsmentioning

confidence: 99%

Development of COX-2 Selective Inhibitors - Therapeutic Perspectives

Casturi¹,

Hegde²,

Ramanujam

2005

CMCIEMA

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Aspirin and conventional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely prescribed for the treatment of musculoskeletal disorders with a major dose limiting gastrointestinal toxicity. However the discovery of inducible second isozyme of cyclooxygenase-2 (COX-2) opened up a new era in therapeutics. The selective COX-2 inhibitors have emerged as a class of compounds for the treatment of inflammatory disorders based on the molecular knowledge, characterization of two distinctive isozymes namely the constitutive cytoprotective cycloooxygenase-1 (COX-1) and the inducible inflammatory COX-2.The current hypothesis is that anti-inflammatory effects are mediated through the inhibition of COX-2 derived inflammatory prostaglandins (PGs), on the contrary the gastrointestinal adverse effects were due to inhibition of constitutive COX-1. The rationale approach is that the selective COX-2 inhibitors may provide a significantly improved gastrointestinal risk-benefit ratio over NSAIDs. However, the withdrawal of Vioxx by Merck & Co from worldwide markets has triggered a debate on the safety of this class as it was observed, that selective inhibition of COX-2 could lead to an imbalance of normal homeostasis resulting in potential cardiovascular risks. Evidence is emerging that the constitutively expressed COX-2 has important role in gastric mucosal protection, renal and the cardiovascular homeostasis. Suppression of endothelial prostacyclin (PGI 2) by highly selective COX-2 inhibitors could lead to myocardial infarction and stroke implicating that COX-2 may have a pivotal role under certain physiological conditions.

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Comparison of Changes in Blood Pressure Measurements and Antihypertensive Therapy in Older, Hypertensive, Ambulatory Care Patients Prescribed Celecoxib or Rofecoxib

Cited by 17 publications

References 32 publications

Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension

Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension

Treatment of chronic pain in persons with dementia: An overview

Development of COX-2 Selective Inhibitors - Therapeutic Perspectives

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