RESEARCH - Meta-analysis of COX-2s and their effects on blood pressure

[Guest guest]

Meta-analysis of Cyclooxygenase-2 Inhibitors and Their Effects on Blood

Pressure

Tai- Aw, MBBS, FRACP; ph Haas, BPharm, BPharmSci(Hons),

MSHPA; Danny Liew, MBBS(Hons), FRACP; Henry Krum, MBBS, PhD, FRACP

Arch Intern Med. 2005;165:(DOI 10.1001/archinte.165.5.IOI50013).

ABSTRACT

Background Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are

widely prescribed and are associated with blood pressure (BP) elevation. The

development of selective cyclooxygenase-2 inhibitors (coxibs) raises the

issue of the magnitude of BP response compared with nonselective NSAIDs. We

therefore performed a meta-analysis comparing the effects of coxibs with

placebo, nonselective NSAIDs, and each other on BP elevation and

hypertension.

Methods Nineteen randomized controlled trials involving coxibs were

published before May 2004, with a total of 45 451 participants in which BP

data were available. The Cohen method statistically combined weighted mean

difference (WMD). The Der Simonian and Laird method pooled results

concerning the relative risk (RR) of developing hypertension and the RR of

clinically important BP elevations.

Results Among the trials analyzed, coxibs caused a WMD point estimate

increase in systolic and diastolic BP compared with placebo (3.85/1.06 mm

Hg) and nonselective NSAIDs (2.83/1.34 mm Hg). Cyclooxygenase-2 inhibitors

were associated with a nonsignificantly higher RR of causing hypertension

compared with placebo (RR, 1.61; 95% confidence interval [CI], 0.91-2.84; P

= .10) and nonselective NSAIDs (RR, 1.25; 95% CI, 0.87-1.78; P = .23).

Rofecoxib induced a WMD point estimate increase in systolic BP (2.83 mm Hg)

and a nonsignificantly higher risk of developing clinically important

systolic BP elevation (RR, 1.50; 95% CI, 1.00-2.26; P = .05) compared with

celecoxib.

Conclusions Cyclooxygenase-2 inhibitors were associated with a

point-estimate BP elevation compared with placebo and nonselective NSAIDs.

There was a nonsignificantly higher incidence of developing hypertension

compared with nonselective NSAIDs, as was observed with rofecoxib compared

with celecoxib. These BP elevations may be clinically significant in

relation to increased cardiovascular risk.

Published online February 14, 2005 (DOI 10.1001/archinte.165.5.IOI50013).

See the whole article here:

http://archinte.ama-assn.org/cgi/content/full/165.5.IOI50013v1

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org