title: The impact of NSAID or COX-2 inhibitor use on the initiation of antihypertensive therapy.
abstract: 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.
authors.affiliation: Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA. muyood@muyood.com
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Emmeline
authors.initials: E
authors.lastname: Watkins
authors.forename: Karen
authors.initials: K
authors.lastname: Wells
authors.forename: Gena
authors.initials: G
authors.lastname: Kucera
authors.forename: Christine Cole
authors.initials: CC
authors.lastname: Johnson
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions; D006285:Health Planning; D011358:Product Surveillance, Postmarketing; D012308:Risk Management / Q000458:organization & administration*