Do COX-2 inhibitors raise blood pressure more than nonselective NSAIDs and placebo? An updated meta-analysis
Do COX-2 inhibitors raise blood pressure more than nonselective NSAIDs and placebo? An updated meta-analysis
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DOI：
10.1097/hjh.0b013e3283310dc9
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发表时间：
2009-12-01
影响因子：
4.9
通讯作者：
Krum, Henry
中科院分区：
文献类型：
--
作者：
Chan, Clara C.;Reid, Christopher M.;Krum, Henry
背景考克斯-2选择性抑制剂（coxibs）和非选择性（ns）-NSAID均升高血压（BP），这可能导致过多的心血管（CV）事件。一些最近的大规模随机临床试验（RCT）比较昔布（包括较新的药物，lumiracoxib和etoricoxib）的NS-NSAIDs和安慰剂已被报道，允许更新到早期的BP分析这些agents.Data source/synthesis我们的搜索产生了51个RCT涉及昔布在2008年4月之前出版的共130541参与者，其中BP数据可用。结果昔布组与安慰剂组发生新发高血压的危险比为1.49（1.18-1.88，P=0.04）。对于昔布类与ns-NSAID，RR为1.12（0.93-1.35，P=0.23）。这些结果主要是由罗非昔布，与安慰剂的RR为1.87（1.63-2.14，P=0.08），和依托考昔，与ns-NSAID.Conclusion的基础上，更新的荟萃分析，昔布类药物产生更大的高血压比ns-NSAIDs或安慰剂的RR为1.52（1.39-1.66，P=0.01）。然而，这种反应是异质性的，罗非昔布和依托昔布显著升高血压，而塞来昔布、伐地昔布和罗美昔布似乎对血压影响不大。高血压风险增加与随后不良CV结局的关系需要进一步研究和前瞻性RCT。J Hypertens 27：2332-2341（c）2009 Wolters Kluwer Health垂直杆Lippincott威廉姆斯& Wilkins。
Background Both COX-2 selective inhibitors (coxibs) and nonselective (ns)-NSAIDs elevate blood pressure (BP) and this may contribute to excess cardiovascular (CV) events. A number of recent large-scale randomized clinical trials (RCTs) comparing coxibs (including newer agents, lumiracoxib and etoricoxib) to both ns-NSAIDs and placebo have been reported, permitting an update to earlier BP analyses of these agents.Data sources/synthesis Our search yielded 51 RCTs involving coxibs published before April 2008 with a total of 130541 participants in which BP data were available. The Der Simonian and Laird random effects method for dichotomous variables was used to produce risk ratios (RR) for development of hypertension.Results For coxibs versus placebo, there was a RR of 1.49 (1.18-1.88, P=0.04) in the development of new hypertension. For coxibs versus ns-NSAIDs, the RR was 1.12 (0.93-1.35, P=0.23). These results were mainly driven by rofecoxib, with a RR of 1.87 (1.63-2.14, P=0.08) versus placebo, and etoricoxib, with a RR of 1.52 (1.39-1.66, P=0.01) versus ns-NSAID.Conclusion On the basis of this updated meta-analysis, coxibs appear to produce greater hypertension than either ns-NSAIDs or placebo. However, this response was heterogeneous, with markedly raised BP associated with rofecoxib and etoricoxib, whereas celecoxib, valdecoxib and lumiracoxib appeared to have little BP effect. The relationship of this increased risk of hypertension to subsequent adverse CV outcomes requires further investigation and prospective RCTs. J Hypertens 27: 2332-2341 (c) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.