The impact of NSAID or COX-2 inhibitor use on the initiation of antihypertensive therapy.
OBJECTIVE
The objective of this study was to quantify the associations between NSAIDs and COX-2 inhibitors and risk for initiating antihypertensive therapy.


METHODS
We conducted a population-based case-control study in a large, integrated health system in the Midwestern United States. Cases (N = 23 562) were new users of antihypertensive therapy from 1, July 1997, through 31, January 2003. Controls (N = 23 562) were randomly selected and matched to cases on age, copay, medical care utilization, sex, and index date. The main outcome measures were exposure to NSAIDs and COX-2 inhibitors.


RESULTS
Recent prescription NSAID use was associated with an increased risk for initiation of antihypertensive therapy (odds ratio (OR) = 1.6, 95%CI 1.5, 1.7) as were selective COX-2 inhibitors (OR = 1.8, 95%CI 1.6, 2.1). After adjusting for age, sex, co-payment, race, and exposure to other NSAIDs/COX-2, each non-selective NSAID (diclofenac, ibuprofen, indomethacin, naproxen, oxaprozin) was associated with an increased risk of antihypertensive therapy initiation, with ORs ranging from 1.4 to 1.8. Recent users of COX-2 inhibitors had an increased risk of initiating antihypertensive therapy, regardless of specific drug (celecoxib adjusted OR = 1.7 (95%CI 1.3, 2.1); rofecoxib adjusted OR = 1.7 (95%CI 1.4, 1.9)).


CONCLUSIONS
A consistent increased risk of initiation of antihypertensive therapy was observed among recent users of NSAIDs and COX-2 inhibitors. Unlike previous studies, the results indicate that the effects of rofecoxib and celecoxib are equivalent.
Yood
Marianne Ulcickas
MU
Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA. muyood@muyood.com
Watkins
Emmeline
E
Wells
Karen
K
Kucera
Gena
G
Johnson
Christine Cole
CC
D064420:Drug-Related Side Effects and Adverse Reactions; D006285:Health Planning; D011358:Product Surveillance, Postmarketing; D012308:Risk Management / Q000458:organization & administration*