Increases in BP, Hypertension Incidence Linked to Certain NSAIDs

Compared to celecoxib, ibuprofen may increase blood pressure in osteoarthritis or rheumatoid arthritis (RA) patients at increased risk of cardiovascular disease. Findings from the PRECISION-ABPM study, a pre-specified four month substudy of the landmark PRECISION trial, were presented at the European Society of Cardiology (ESC) Congress.

Nonsteroidal anti-inflammatory drugs (NSAIDs), though widely used, carry warnings regarding the risk of serious cardiovascular events. However, information on how individual NSAIDs, both non-selective and selective cyclooxygenase-2 (COX-2) inhibitors, affect blood pressure is limited.

The PRECISION-ABPM study included 444 patients (408 with osteoarthritis; 36 RA) who had evidence of, or were at increased risk for, coronary artery disease. These patients were randomized to receive one of the following treatments or a matching placebo:

• Celecoxib 100–200mg twice daily
• Ibuprofen 600–800mg three times daily
• Naproxen 375–500mg twice daily

The primary endpoint of the study was the change from baseline in 24-hour ambulatory blood pressure after four months.

The researchers found that both ibuprofen and naproxen increased the average systolic blood pressure by 3.7mmHg and 1.6mmHg, respectively, while celecoxib-treated patients saw a decrease of –0.3mmHg; the difference between celecoxib and ibuprofen (–3.9mmHg) was considered significant (P=0.009). In addition, compared to celecoxib-treated patients, a greater percentage of patients with normal baseline blood pressure treated with naproxen and ibuprofen developed hypertension (10.3% vs. 19.0% vs. 23.2%, respectively).

“The current findings suggest that the elevated cardiovascular risk with NSAIDs may be partly due to drug-specific increases in blood pressure,” said principal investigator Professor Frank Ruschitzka, professor of cardiology and co-head, Department of Cardiology, University Heart Centre, Zurich, Switzerland. “This challenges the widely advocated belief that conventional NSAIDs, like naproxen and ibuprofen, with their higher COX-1 (and thromboxane reducing) effects would provide greater cardiovascular safety than other more COX-2 selective agents, particularly celecoxib.”

Based on these findings, the authors recommend that clinicians consider the blood pressure effects of these medications before treating patients with comorbid arthritis and hypertension.

More information on this study is published in the European Heart Journal.