Factors associated with blood pressure changes in patients receiving diclofenac or etoricoxib: results from the MEDAL study.
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.
Krum
Henry
H
Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia. henry.krum@med.monash.edu.au
Swergold
Gary
G
Curtis
Sean P
SP
Kaur
Amarjot
A
Wang
Hongwei
H
Smugar
Steven S
SS
Weir
Matthew R
MR
Laine
Loren
L
Brater
D Craig
DC
Cannon
Christopher P
CP
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*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D011725:Pyridines; D013450:Sulfones; D004008:Diclofenac; D000077613:Etoricoxib