Treating osteoarthritis with cyclooxygenase-2-specific inhibitors - What are the benefits of avoiding blood pressure destabilization?
Treating osteoarthritis with cyclooxygenase-2-specific inhibitors - What are the benefits of avoiding blood pressure destabilization?
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DOI：
10.1161/01.hyp.0000149684.01903.b8
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发表时间：
2005-01-01
期刊：
影响因子：
8.3
通讯作者：
Zowall, H
中科院分区：
文献类型：
--
作者：
Grover, SA;Coupal, L;Zowall, H
骨关节炎和高血压在美国老年人中非常普遍。抗炎药物会使血压控制不稳定。我们评估了在服用环氧合酶-2（考克斯-2）特异性抑制剂治疗骨关节炎的高血压美国人中，如果血压控制不稳定，可以避免的心血管风险降低、过早死亡和直接医疗费用。来自第三次全国健康和营养检查调查（NHANES III）的数据提供了美国成年骨关节炎和高血压患者心血管危险因素的分布。根据比较考克斯-2特异性抑制剂的随机试验结果，使用心血管疾病预期寿命模型估计收缩压升高2.26%的影响。对患有骨关节炎和未经治疗的高血压（大于或等于140/90 mm Hg）的美国成年人进行了类似的分析。在730万接受高血压治疗的美国人中，维持血压控制将避免> 30 000例中风死亡和25 000例冠状动脉死亡，从而挽救> 449 000人年的生命，并节省14亿美元的直接医疗保健费用。当考虑到另外380万患有未经治疗的高血压的美国人时，保持血压控制可以预防> 47000例中风死亡，39000例冠状动脉死亡，并导致668000人年的生命挽救和> 24亿美元的直接医疗保健成本节省。我们的结论是，即使是一个小的增加收缩压高血压的美国人骨关节炎可能会大大增加心血管疾病的临床和经济负担。保持血压控制可能与实质性益处相关。
Osteoarthritis and hypertension are highly prevalent among older Americans. Anti-inflammatory medications can destabilize blood pressure control. We estimated the decreased cardiovascular risk, premature mortality, and direct health care costs that could be avoided if blood pressure control is not destabilized among hypertensive Americans taking cyclooxygenase-2 (COX-2) -specific inhibitors for osteoarthritis. Data from the Third National Health and Nutrition Examination Survey ( NHANES III) provided the distribution of cardiovascular risk factors among American adults with osteoarthritis and hypertension. The Cardiovascular Disease Life Expectancy Model was used to estimate the impact of a 2.26% increase in systolic blood pressure on the basis of results of a randomized trial comparing COX-2 -specific inhibitors. A similar analysis was completed for American adults with osteoarthritis and untreated hypertension ( greater than or equal to 140/90 mm Hg). Among 7.3 million Americans with treated hypertension, maintaining blood pressure control would avoid > 30 000 stroke deaths and 25 000 coronary deaths resulting in > 449 000 person years of life saved and $1.4 billion in direct health care cost savings. When an additional 3.8 million Americans with untreated hypertension are considered, maintaining blood pressure control could prevent > 47 000 stroke deaths, 39 000 coronary deaths, and result in 668 000 person years of life saved and >$2.4 billion in direct health care cost savings. We conclude that even a small increase in systolic blood pressure among hypertensive Americans with osteoarthritis may substantially increase the clinical and economic burden of cardiovascular disease. Maintaining blood pressure control may be associated with substantial benefits.