title: Factors associated with blood pressure changes in patients receiving diclofenac or etoricoxib: results from the MEDAL study.
abstract: OBJECTIVE
  To evaluate the hypertensive effects of etoricoxib and diclofenac relative to baseline hypertension risk factors in arthritis patients.
  
  
  METHODS
  Multivariate analysis of data from the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) study (n = 23 504). We evaluated risk factors for change in systolic blood pressure (BP) (SBP) and diastolic BP (DBP) at 4 months versus baseline; exceeding predefined limits of change (PLoC) in BP anytime during the study; and the effect of concomitant antihypertensive class on SBP and exceeding SBP PLoC.
  
  
  RESULTS
  Increased SBP was most highly associated with history of hypertension (+3.04 mmHg; P < 0.0001), as were increased DBP (+1.28 mmHg; P < 0.0001), and exceeding DBP PLoC [odds ratio (OR) = 1.83; P < 0.0001]. Exceeding SBP PLoC (OR = 1.50; P < 0.0001) was most highly associated with age at least 65 years. Etoricoxib (vs. diclofenac) was also significantly associated with increased SBP (P < 0.0001), DPB (P < 0.0001 to P = 0.0015), and exceeding SBP PLoC (P < 0.0001 to P = 0.002). Compared with no antihypertensive medication, background calcium channel blockers (CCB) were associated with a small, nonsignificant decrease in SBP (-0.60 mmHg) and no increased odds of exceeding SBP PLoC [OR = 1.00 (95% CI 0.71, 1.42)]. All other antihypertensive classes were associated with either no change or numerically or statistically significantly increased SBP and increased odds of exceeding PLoC.
  
  
  CONCLUSIONS
  History of hypertension and age at least 65 years were most strongly associated with increased BP. Treatment with etoricoxib vs. diclofenac was also a significant factor for increased BP. CCBs appear to maintain antihypertensive effects with concurrent NSAID therapy better than other examined antihypertensive drug classes.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia. henry.krum@med.monash.edu.au
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Gary
authors.initials: G
authors.lastname: Swergold
authors.forename: Sean P
authors.initials: SP
authors.lastname: Curtis
authors.forename: Amarjot
authors.initials: A
authors.lastname: Kaur
authors.forename: Hongwei
authors.initials: H
authors.lastname: Wang
authors.forename: Steven S
authors.initials: SS
authors.lastname: Smugar
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
authors.forename: D Craig
authors.initials: DC
authors.lastname: Brater
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D004008:Diclofenac / Q000009:adverse effects*; D000077613:Etoricoxib; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010003:Osteoarthritis / Q000188:drug therapy* / Q000503:physiopathology; D011725:Pyridines / Q000009:adverse effects*; D013450:Sulfones / Q000009:adverse effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D011725:Pyridines; D013450:Sulfones; D004008:Diclofenac; D000077613:Etoricoxib