Treating osteoarthritis with cyclooxygenase-2-specific inhibitors: what are the benefits of avoiding blood pressure destabilization?
Osteoarthritis and hypertension are highly prevalent among older Americans. Anti-inflammatory medications can destabilize blood pressure control. We estimated the decreased cardiovascular risk, premature mortality, and direct health care costs that could be avoided if blood pressure control is not destabilized among hypertensive Americans taking cyclooxygenase-2 (COX-2)-specific inhibitors for osteoarthritis. Data from the Third National Health and Nutrition Examination Survey (NHANES III) provided the distribution of cardiovascular risk factors among American adults with osteoarthritis and hypertension. The Cardiovascular Disease Life Expectancy Model was used to estimate the impact of a 2.26% increase in systolic blood pressure on the basis of results of a randomized trial comparing COX-2-specific inhibitors. A similar analysis was completed for American adults with osteoarthritis and untreated hypertension (> or =140/90 mm Hg). Among 7.3 million Americans with treated hypertension, maintaining blood pressure control would avoid >30,000 stroke deaths and 2,000 coronary deaths resulting in >449,000 person years of life saved and 1.4 billion dollars in direct health care cost savings. When an additional 3.8 million Americans with untreated hypertension are considered, maintaining blood pressure control could prevent >47,000 stroke deaths, 39,000 coronary deaths, and result in 668,000 person years of life saved and >2.4 billion dollars in direct health care cost savings. We conclude that even a small increase in systolic blood pressure among hypertensive Americans with osteoarthritis may substantially increase the clinical and economic burden of cardiovascular disease. Maintaining blood pressure control may be associated with substantial benefits.
Grover
Steven A
SA
Centre for the Analysis of Cost-Effective Care and Division of General Internal Medicine, The Montreal General Hospital, Montreal, Quebec, Canada. steven.grover@mcgill.ca
Coupal
Louis
L
Zowall
Hanna
H
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D000068579:Celecoxib; D015331:Cohort Studies; D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D017046:Cost Savings; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D007783:Lactones / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008955:Models, Cardiovascular; D010003:Osteoarthritis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011720:Pyrazoles / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D013449:Sulfonamides / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013450:Sulfones / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D016861:Cyclooxygenase Inhibitors; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D000068579:Celecoxib