Blood Pressure and Cardiovascular Outcomes in Patients Taking Nonsteroidal Antiinflammatory Drugs
Key result
Higher baseline systolic blood pressure links to increased thrombotic CV risk on etoricoxib or diclofenac.
- n=34,701
Why the study?
The increased thrombotic cardiovascular risk with COX-2 inhibitors and NSAIDs may be related to their potential to elevate blood pressure, but this relationship is unclear.
Does baseline blood pressure or change in blood pressure predict cardiovascular events in patients taking etoricoxib or diclofenac?
Population
34,701 patients receiving NSAIDs or COX-2 inhibitors in the Multinational Etoricoxib and Diclofenac Arthritis Long-term Program
Comparison
Etoricoxib 60 or 90 mg daily vs diclofenac 150 mg daily
Design
Prospective randomized double-blind trial
Follow-up
Mean 18 months
Authors
Discussion
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Member takes
Implication
Baseline SBP predicts thrombotic events on etoricoxib or diclofenac; challenges BP elevation as the primary driver of NSAID-related CV risk.
Study Design
Type
RCT (n=34,701)
Blinding
double-blind
Randomization
randomized
Multicenter
Yes
Structured PICO
Does baseline blood pressure or change in blood pressure predict cardiovascular events in patients taking etoricoxib or diclofenac?
P
Population
34,701 patients with arthritis receiving etoricoxib or diclofenac, followed for a mean duration of 18 months.
I
Intervention
Etoricoxib 60 or 90 mg daily
C
Comparator
Diclofenac 150 mg daily
O
Outcome
Confirmed thrombotic cardiovascular eventshard clinical
The increased thrombotic cardiovascular risk associated with COX-2 inhibitors and NSAIDs does not appear to be primarily driven by their blood pressure-elevating effects.
Limitations
- Analyses from randomized controlled trials are unable to definitively exclude a relationship between the blood pressure-elevating effects of COX-2s and NSAIDs and cardiovascular risk.
- Analyses from randomized controlled trials are unable to definitively exclude a relationship between BP-elevating effects and CV risk
Cite This Study
Krum et al. (2011) conducted an RCT in Arthritis (n=34,701). Etoricoxib vs. Diclofenac 150 mg daily was evaluated on Confirmed thrombotic cardiovascular events. Baseline systolic blood pressure was significantly associated with a higher risk of thrombotic cardiovascular events in patients taking etoricoxib or diclofenac (P<0.001).