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(Hypertension. 2004;44:140.)
© 2004 American Heart Association, Inc.

Scientific Contributions

Relationship Between COX-2 Specific Inhibitors and Hypertension

Daniel H. Solomon; Sebastian Schneeweiss; Raisa Levin; Jerry Avorn

From the Division of Pharmacoepidemiology and Pharmacoeconomics (D.H.S., S.S., R.L., J.A.), Division of Rheumatology, Immunology, and Allergy (D.H.S.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Daniel H. Solomon, MD, MPH, Division of Pharmacoepidemiology, Brigham and Women’s Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120. E-mail dhsolomon{at}partners.org

There is controversy whether cyclooxygenase-2 (COX-2) specific inhibitors are associated with elevations in blood pressure requiring treatment in typical clinical practice. We examined the risk of new onset hypertension in a retrospective case-control study involving 17 844 subjects aged 65 years from 2 US states. Multivariable logistic models were examined to assess the relative risk of new onset hypertension requiring treatment in patients who used celecoxib or rofecoxib compared with patients taking either the other COX-2 specific inhibitor, a nonspecific NSAID, or no NSAID. During the 1999 to 2000 study period, 3915 patients were diagnosed and began treatment for hypertension; 4 controls were selected for every case. In no model was celecoxib significantly associated with the development of hypertension. Rofecoxib users were at a significantly increased relative risk of new onset hypertension compared with patients taking celecoxib (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.2 to 2.1), taking a nonspecific NSAID (OR 1.4; 95% CI, 1.1 to 1.9), or taking no NSAID (OR 1.6; 95% CI, 1.3 to 2.0). There were no clear dosage or duration effects. In patients with a history of chronic renal disease, liver disease, or congestive heart failure, the relative risk of new onset hypertension was twice as high in those taking rofecoxib compared with celecoxib (OR 2.1; 95% CI, 1.0 to 4.3). In this retrospective case-control study of patients aged 65 years, rofecoxib use was associated with an increased relative risk of new onset hypertension; this was not seen in patients taking celecoxib.

Key Words: cyclooxygenase • drug therapy • hypertension, detection and control • epidemiology

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