COX-2 Inhibitors: Effects on Blood Pressure in a Veterans Affairs Medical Center

Abstract

Background

Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with elevated blood pressure. The effect of COX-2 inhibitors on blood pressure, however, has not been well established.

Objectives

This study aimed to determine the effects of COX-2 inhibitors on blood pressure and whether these effects represented a class effect or specific drug differences.

Methods

Patients were randomly selected from a computer-generated list of all patients actively taking a COX-2 inhibitor as of July 2001; electronic and paper medical records for these patients were retrospectively reviewed. Data collection included patient demographics, medication history, and blood pressure measurements.

Results

A total of 75 patients receiving rofecoxib and 25 patients receiving celecoxib were evaluated. After initiation of rofecoxib therapy, average systolic blood pressure increased from 131.4 ± 13.1 mmHg to 135.7 ± 17.4 mmHg (P = 0.012). Patients started on celecoxib demonstrated an average systolic blood pressure decrease, from 136.3 ± 23 mmHg to 129.6 ± 21.9 mmHg (P = 0.042). No statistically significant changes in diastolic blood pressure were observed. No change in systolic blood pressure was observed in 16 celecoxib-treated patients (64%) and 29 rofecoxib-treated patients (38.7%). A total of 8 patients (8%) (1 celecoxibtreated and 7 rofecoxib-treated) experienced increases in systolic blood pressure greater than 20 mmHg during therapy.

Conclusion

Blood pressure changes may be unique for each COX-2 inhibitor agent and not the result of a class effect. Blood pressure should be monitored in all patients receiving COX-2 inhibitors. Additional prospective studies that assess the effect of COX-2 inhibitors on cardiovascular outcomes should be conducted.