Analysis of 19 randomized controlled trials involving cyclooxygenase-2 inhibitors (COX-2 inhibitors) suggests they raise blood pressure more than conventional nonsteroidal anti-inflammatory drugs (NSAIDs), according to an article published online February 14th by the Archives of Internal Medicine.

NSAIDs, among the most widely prescribed drugs for pain relief, are associated with gastrointestinal side effects. As a result there has been a significant preference to prescribe COX-2 inhibitors over conventional NSAIDs, even when patients do not meet specified criteria for treatment, according to background information in the article. Some COX-2 inhibitors have been associated with increased risk of cardiovascular events.

Tai-Juan Aw, MBBS, FRACP and his Australian colleagues analyzed data from all 19 randomized controlled trials of COX-2 inhibitors published before May 2004, with a total of 45,451 participants for whom blood pressure data were available. The meta-analysis was designed to compare the relative risk of developing hypertension and of clinically important blood pressure elevation in study participants treated with COX-2 inhibitors versus those treated with NSAIDs or placebo.

COX-2 inhibitors were associated with a blood pressure elevation compared with NSAIDs and placebos. These blood pressure elevations may be clinically significant in relation to increased cardiovascular risk. The authors also saw differences between the COX-2 inhibitors.

They wrote "Rofecoxib appears to confer a greater risk of developing hypertension and clinically important elevations in both systolic and diastolic blood pressure compared with celecoxib."

Although COX-2 inhibitors have been considered to be a welcome therapeutic option for arthritis, the authors concluded, "their potential (and differential) effect on blood pressure elevation requires caution in their use and warrants further investigation. Clinicians need to weigh the risks of improved gastrointestinal safety versus potential hazards of developing elevated blood pressure when considering the use of these agents, especially in the elderly population."