Do COX-2 inhibitors raise blood pressure more than nonselective NSAIDs and placebo? An updated meta-analysis
MetadataShow full item record
BACKGROUND: Both COX-2 selective inhibitors (coxibs) and nonselective (ns)-NSAIDs elevate blood pressure (BP) and this may contribute to excess cardiovascular (CV) events. A number of recent large-scale randomized clinical trials (RCTs) comparing coxibs (including newer agents, lumiracoxib and etoricoxib) to both ns-NSAIDs and placebo have been reported, permitting an update to earlier BP analyses of these agents. DATA SOURCES/SYNTHESIS: Our search yielded 51 RCTs involving coxibs published before April 2008 with a total of 130 541 participants in which BP data were available. The Der Simonian and Laird random effects method for dichotomous variables was used to produce risk ratios (RR) for development of hypertension. RESULTS: For coxibs versus placebo, there was a RR of 1.49 (1.18g€"1.88, P = 0.04) in the development of new hypertension. For coxibs versus ns-NSAIDs, the RR was 1.12 (0.93g€"1.35, P = 0.23). These results were mainly driven by rofecoxib, with a RR of 1.87 (1.63g€"2.14, P = 0.08) versus placebo, and etoricoxib, with a RR of 1.52 (1.39g€"1.66, P = 0.01) versus ns-NSAID. CONCLUSION: On the basis of this updated meta-analysis, coxibs appear to produce greater hypertension than either ns-NSAIDs or placebo. However, this response was heterogeneous, with markedly raised BP associated with rofecoxib and etoricoxib, whereas celecoxib, valdecoxib and lumiracoxib appeared to have little BP effect. The relationship of this increased risk of hypertension to subsequent adverse CV outcomes requires further investigation and prospective RCTs. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Showing items related by title, author, creator and subject.
Quarter-dose quadruple combination therapy for initial treatment of hypertension: Placebo-controlled, crossover, randomised trial and systematic reviewChow, C.; Thakkar, J.; Bennett, A.; Hillis, G.; Burke, M.; Usherwood, T.; Vo, K.; Rogers, K.; Atkins, E.; Webster, R.; Chou, M.; Dehbi, H.; Salam, A.; Patel, A.; Neal, B.; Peiris, D.; Krum, H.; Chalmers, J.; Nelson, M.; Reid, Christopher; Woodward, M.; Hilmer, S.; Thom, S.; Rodgers, A. (2017)Background: Globally, most patients with hypertension are treated with monotherapy, and control rates are poor because monotherapy only reduces blood pressure by around 9/5 mm Hg on average. There is a pressing need for ...
Neratinib after trastuzumab-based adjuvant therapy in patients with HER2-positive breast cancer (ExteNET): A multicentre, randomised, double-blind, placebo-controlled, phase 3 trialChan, Arlene; Delaloge, S.; Holmes, F.; Moy, B.; Iwata, H.; Harvey, V.; Robert, N.; Silovski, T.; Gokmen, E.; von Minckwitz, G.; Ejlertsen, B.; Chia, S.; Mansi, J.; Barrios, C.; Gnant, M.; Buyse, M.; Gore, I.; Smith, J.; Harker, G.; Masuda, N.; Petrakova, K.; Zotano, A.; Iannotti, N.; Rodriguez, G.; Tassone, P.; Wong, A.; Bryce, R.; Ye, Y.; Yao, B.; Martin, M. (2016)Background: Neratinib, an irreversible tyrosine-kinase inhibitor of HER1, HER2, and HER4, has clinical activity in patients with HER2-positive metastatic breast cancer. We aimed to investigate the efficacy and safety of ...
Legacy Effect of Delayed Blood Pressure-Lowering Pharmacotherapy in Middle-Aged Individuals Stratified by Absolute Cardiovascular Disease Risk: Protocol for a Systematic Review.Ho, C.; Sanders, S.; Doust, J.; Breslin, M.; Reid, Christopher; Nelson, M. (2017)BACKGROUND: Many national and international guidelines recommend that the initiation of blood pressure (BP)-lowering drug treatment for the primary prevention of cardiovascular disease (CVD) should no longer be based on ...