Article

Current Hypertension Reports

, Volume 12, Issue 4, pp 258-266

First online:

Do the Blood Pressure Effects of Nonsteroidal Antiinflammatory Drugs Influence Cardiovascular Morbidity and Mortality?

  • William J. ElliottAffiliated withDivision of Pharmacology, Pacific Northwest University of Health Sciences Email author 

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Abstract

There are many theories about why selective inhibitors of the second isoform of cyclooxygenase (COX-2) increase cardiovascular risk. Although torcetrapib raises blood pressure and cardiovascular risk, it has been difficult to prove such a link for COX-2 inhibitors in randomized clinical trials. This review shows a significant correlation in placebo-controlled trials between the five agents’ elevations in blood pressures and their rate ratios for cardiovascular events. A larger body of evidence arises from randomized clinical trial comparisons of selective versus nonselective inhibitors of COX-2, but these results are heterogeneous for naproxen versus other traditional agents. The best current trial evidence comes from the centrally adjudicated placebo-controlled trials of celecoxib for colonic polyps: If the blood pressure did not rise at 1 or 3 years after randomization, cardiovascular risk did not significantly increase. Many more data will become available in 2013, after the only prospective clinical trial involving cardiovascular end points is completed.

Keywords

Meta-analysis Celecoxib Rofecoxib Valdecoxib Etoricoxib Parecoxib Lumiracoxib COX-2 inhibitors Incident hypertension Composite cardiovascular end point