Blood pressure and cardiovascular outcomes in patients taking nonsteroidal antiinflammatory drugs
Cardiovascular Therapeutics,  Clinical Article

Krum H et al. – Baseline blood pressure (BP), but not change in BP, was significantly associated with risk of thrombotic CVEs through 18 months. The cardiovascular (CV) risk of COX–2s and NSAIDs did not appear to be related to the BP–elevating effects of these agents, although such analyses, i.e., from randomized controlled trials, are unable to definitively exclude such a relationship.

Methods
  • The prospective randomized, double–blind.
  • Multinational Etoricoxib and Diclofenac Arthritis Long–term Program (N = 34,701) comparing etoricoxib 60 or 90 mg or diclofenac 150 mg daily for a mean duration of 18 months.
  • The main outcome measure was confirmed thrombotic CVEs.
  • The Antiplatelet Trialists’ Collaboration endpoint, all–cause mortality, CV/congestive heart failure (CHF) mortality, and CHF incidence were similarly evaluated.

Results
  • Authors found that baseline systolic BP (SBP) was associated with significantly higher risk of all events (P < 0.001).
  • Baseline diastolic BP (DBP) was inversely and significantly associated with risk of all events (P < 0.001 to P= 0.016) except CV/CHF mortality (P= 0.054).
  • There was no significant differential effect between etoricoxib and diclofenac in relation to CVEs, except for confirmed CHF, for which the risk was significantly higher with etoricoxib (P= 0.019).
  • Only CHF risk (P= 0.020 for both SBP and DBP change), but not thrombotic endpoints, was significantly associated with change in BP from months 0 to 4.
  • These findings were not meaningfully altered after covariate adjustment for baseline CV risk

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