Do the blood pressure effects of nonsteroidal antiinflammatory drugs influence cardiovascular morbidity and mortality?
There are many theories about why selective inhibitors of the second isoform of cyclooxygenase (COX-2) increase cardiovascular risk. Although torcetrapib raises blood pressure and cardiovascular risk, it has been difficult to prove such a link for COX-2 inhibitors in randomized clinical trials. This review shows a significant correlation in placebo-controlled trials between the five agents' elevations in blood pressures and their rate ratios for cardiovascular events. A larger body of evidence arises from randomized clinical trial comparisons of selective versus nonselective inhibitors of COX-2, but these results are heterogeneous for naproxen versus other traditional agents. The best current trial evidence comes from the centrally adjudicated placebo-controlled trials of celecoxib for colonic polyps: If the blood pressure did not rise at 1 or 3 years after randomization, cardiovascular risk did not significantly increase. Many more data will become available in 2013, after the only prospective clinical trial involving cardiovascular end points is completed.
Division of Pharmacology, Pacific Northwest University of Health Sciences, 200 University Parkway, Yakima, WA 98901, USA. wj.elliott@yahoo.com
William J
WJ
Elliott
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D004008:Diclofenac / Q000009:adverse effects / Q000031:analogs & derivatives; D000077613:Etoricoxib; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007555:Isoxazoles / Q000009:adverse effects; D007783:Lactones / Q000009:adverse effects; D011720:Pyrazoles / Q000009:adverse effects; D011725:Pyridines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D012306:Risk; D012307:Risk Factors; D013449:Sulfonamides / Q000009:adverse effects; D013450:Sulfones / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000096926:Benzenesulfonamides
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors; D004008:Diclofenac; D000077613:Etoricoxib; D007555:Isoxazoles; D007783:Lactones; D011720:Pyrazoles; D011725:Pyridines; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; C406224:valdecoxib; D000096926:Benzenesulfonamides; C409945:parecoxib; C473384:lumiracoxib