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- Title
Blood Pressure and Cardiovascular Outcomes in Patients Taking Nonsteroidal Antiinflammatory Drugs.
- Authors
Krum, Henry; Swergold, Gary; Gammaitoni, Arnold; Peloso, Paul M.; Smugar, Steven S.; Curtis, Sean P.; Brater, D. Craig; Wang, Hongwei; Kaur, Amarjot; Laine, Loren; Weir, Matthew R.; Cannon, Christopher P.
- Abstract
SUMMARY Introduction: The increased thrombotic cardiovascular (CV) risk in trials of cyclo-oxygenase-2 (COX-2) inhibitors versus placebo, and the apparent similar risk with nonsteroidal antiinflammatory drugs (NSAIDs), may be related to their potential to elevate blood pressure (BP). Aims: We evaluated the relationship between baseline BP and change in BP on CV events (CVEs) in patients receiving NSAIDs or COX-2 inhibitors in the prospective randomized, double-blind, Multinational Etoricoxib and Diclofenac Arthritis Long-term Program (N = 34,701) comparing etoricoxib 60 or 90 mg or diclofenac 150 mg daily for a mean duration of 18 months. The main outcome measure was confirmed thrombotic CVEs. The Antiplatelet Trialists' Collaboration endpoint, all-cause mortality, CV/congestive heart failure (CHF) mortality, and CHF incidence were similarly evaluated. Results: We found that baseline systolic BP (SBP) was associated with significantly higher risk of all events ( P < 0.001). Baseline diastolic BP (DBP) was inversely and significantly associated with risk of all events ( P < 0.001 to P= 0.016) except CV/CHF mortality ( P= 0.054). There was no significant differential effect between etoricoxib and diclofenac in relation to CVEs, except for confirmed CHF, for which the risk was significantly higher with etoricoxib ( P= 0.019). Only CHF risk ( P= 0.020 for both SBP and DBP change), but not thrombotic endpoints, was significantly associated with change in BP from months 0 to 4. These findings were not meaningfully altered after covariate adjustment for baseline CV risk. Conclusions: Baseline BP, but not change in BP, was significantly associated with risk of thrombotic CVEs through 18 months. The CV risk of COX-2s and NSAIDs did not appear to be related to the BP-elevating effects of these agents, although such analyses, i.e., from randomized controlled trials, are unable to definitively exclude such a relationship.
- Subjects
BLOOD pressure; NONSTEROIDAL anti-inflammatory agents; THROMBOEMBOLISM risk factors; RANDOMIZED controlled trials; CONGESTIVE heart failure; DICLOFENAC
- Publication
Cardiovascular Therapeutics, 2012, Vol 30, Issue 6, p342
- ISSN
1755-5914
- Publication type
Article
- DOI
10.1111/j.1755-5922.2011.00283.x