Key result
History of hypertension was most strongly associated with increased systolic blood pressure (+3.04 mmHg; P<0.0001), while etoricoxib also significantly increased blood pressure compared to diclofenac.
Why the study?
Does etoricoxib compared to diclofenac increase blood pressure in arthritis patients?
Observational (n=23,504)
Yes
Does etoricoxib compared to diclofenac increase blood pressure in arthritis patients?
Mean Difference: 3.04
p-value: p=<0.0001
In arthritis patients, etoricoxib use, history of hypertension, and age ≥65 years are strongly associated with increased blood pressure, while calcium channel blockers appear to best maintain BP control during concurrent NSAID therapy.
May warrant closer BP monitoring with etoricoxib in hypertensive arthritis patients; leaves open effects on CV outcomes.
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. CONCLUSION: 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.
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Krum et al. (2009) conducted an observational in Arthritis (n=23,504). History of hypertension vs. No history of hypertension was evaluated on Change in systolic blood pressure (SBP) at 4 months versus baseline (MD +3.04 mmHg, p=<0.0001). History of hypertension was most strongly associated with increased systolic blood pressure (+3.04 mmHg; P<0.0001), while etoricoxib also significantly increased blood pressure compared to diclofenac.
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