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Relationship between COX-2 specific inhibitors and hypertension
Daniel H Solomon1, Sebastian Schneeweiss, Raisa Levin
1Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02120, USA. dhsolomon@partners.org
Hypertension (Dallas, Tex. : 1979)
|July 1, 2004
Summary
Rofecoxib use, unlike celecoxib, significantly increased the risk of new-onset hypertension in older adults. This association was particularly pronounced in patients with pre-existing kidney or heart conditions.
Area of Science:
- Cardiovascular pharmacology
- Geriatric medicine
- Pharmacoepidemiology
Background:
- Controversy exists regarding the association between cyclooxygenase-2 (COX-2) specific inhibitors and elevated blood pressure requiring treatment.
- Older adults represent a vulnerable population for cardiovascular events and medication side effects.
Purpose of the Study:
- To examine the risk of new-onset hypertension associated with the use of COX-2 specific inhibitors (celecoxib and rofecoxib) in patients aged 65 years and older.
- To compare the hypertension risk of these agents against non-specific NSAIDs and no NSAID use.
Main Methods:
- Retrospective case-control study involving 17,844 subjects aged 65 years or older from two US states.
- Multivariable logistic regression models were used to assess the relative risk of new-onset hypertension.
- Cases were patients diagnosed with and treated for hypertension; four controls were selected for each case.
Main Results:
- Celecoxib use was not significantly associated with the development of new-onset hypertension in any model.
- Rofecoxib users showed a significantly increased relative risk of new-onset hypertension compared to users of celecoxib, non-specific NSAIDs, or no NSAID.
- The relative risk of new-onset hypertension in patients with a history of chronic renal disease, liver disease, or congestive heart failure was twice as high for rofecoxib users compared to celecoxib users.
Conclusions:
- Rofecoxib use is associated with an increased relative risk of new-onset hypertension in older adults.
- Celecoxib did not demonstrate a significant association with new-onset hypertension in this population.
- The findings suggest differential cardiovascular safety profiles among COX-2 inhibitors, particularly concerning blood pressure regulation in the elderly.