Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure
Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure
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DOI：
10.1001/archinte.165.5.ioi50013
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发表时间：
2005-03-14
影响因子：
--
通讯作者：
Krum, H
中科院分区：
文献类型：
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作者：
Aw, TJ;Haas, SJ;Krum, H
背景：非选择性非甾体抗炎药（NSAID）被广泛使用，并且与血压（BP）升高有关。与非选择性 NSAID 相比，选择性环氧合酶 2 抑制剂 (coxib) 的开发提出了血压反应程度的问题。因此，我们进行了一项荟萃分析，比较了昔布类药物与安慰剂、非选择性 NSAIDs 以及彼此之间对血压升高和高血压的影响。方法：2004 年 5 月之前发表了 19 项涉及昔布类药物的随机对照试验，共有 45 451 名受试者参与，其中有可用的血压数据。 Cohen方法统计结合加权平均差（WMD）。 Der Simonian 和 Laird 方法汇总了有关发生高血压的相对风险 (RR) 和临床上重要的血压升高的 RR 的结果。 结果：在分析的试验中，与安慰剂 (3.85/1.06 mm Hg) 和非选择性 NSAIDs (2.83/1.34 mm Hg) 相比，昔布引起收缩压和舒张压的 WMD 点估计值升高。与安慰剂（RR，1.61；95%置信区间[Cl]，0.91-2.84；P=.10）和非选择性非甾体抗炎药（RR，1.25；95% CI，0.87-1.78；P=.23）相比，环氧合酶-2抑制剂与引起高血压的RR不显着升高相关。与塞来昔布相比，罗非考昔引起 WMD 点估计收缩压升高 (2.83 mm Hg)，并且与塞来昔布相比，发生临床重要收缩压升高的风险无显着升高 (RR, 1.50; 95% Cl, 1.00-2.26; P=.05)。 结论：与安慰剂相比，Cyclooxygenase-2 抑制剂与点估计血压升高相关和非选择性非甾体抗炎药。与非选择性非甾体抗炎药相比，罗非考昔与塞来昔布相比，发生高血压的发生率没有显着升高。这些血压升高可能与心血管风险增加相关，具有临床意义。
Background: Nonselective nonsteroidal antiinflammatory drugs (NSAIDs) are widely prescribed and are associated with blood pressure (BP) elevation. The development of selective cyclooxygenase-2 inhibitors (coxibs) raises the issue of the magnitude of BP response compared with nonselective NSAIDs. We therefore performed a meta-analysis comparing the effects of coxibs with placebo, nonselective NSAIDs, and each other on BP elevation and hypertension.Methods: Nineteen randomized controlled trials involving coxibs were published before May 2004, with a total of 45 451 participants in which BP data were available. The Cohen method statistically combined weighted mean difference (WMD). The Der Simonian and Laird method pooled results concerning the relative risk (RR) of developing hypertension and the RR of clinically important BP elevations.Results: Among the trials analyzed, coxibs caused a WMD point estimate increase in systolic and diastolic BP compared with placebo (3.85/1.06 mm Hg) and nonselective NSAIDs (2.83/1.34 mm Hg). Cyclooxygenase-2 inhibitors were associated with a nonsignificantly higher RR of causing hypertension compared with placebo (RR, 1.61; 95% confidence interval [ Cl], 0.91-2.84; P =. 10) and nonselective NSAIDs (RR, 1.25; 95% Cl, 0.87-1.78; P=.23). Rofecoxib induced a WMD point estimate increase in systolic BP (2.83 mm Hg) and a nonsignificantly higher risk of developing clinically important systolic BP elevation (RR, 1.50; 95% Cl, 1.00-2.26; P=.05) compared with celecoxib.Conclusions: Cyclooxygenase-2 inhibitors were associated with a point-estimate BP elevation compared with placebo and nonselective NSAIDs. There was a nonsignificantly higher incidence of developing hypertension compared with nonselective NSAIDs, as was observed with rofecoxib compared with celecoxib. These BP elevations may be clinically significant in relation to increased cardiovascular risk.