Document Detail

Effects of COX inhibition on blood pressure and kidney function in ACE inhibitor-treated blacks and hispanics.
MedLine Citation:
PMID:  14744921     Owner:  NLM     Status:  MEDLINE    
Cyclo-oxygenase (COX) inhibitors attenuate the antihypertensive effects of angiotensin-converting enzyme (ACE) inhibitors and reduce kidney function. The study tests the hypothesis that these two classes of drugs have similar effects on glomerular filtration rate (GFR) and 24-hour blood pressure. The primary endpoint was change in 24-hour systolic blood pressure. Using a randomized crossover design, 25 black and Hispanic hypertensive participants (mean age 58+/-3 years) with osteoarthritis were studied. All participants received an ACE inhibitor at baseline. Once systolic blood pressure was <140 mm Hg, either celecoxib 200 mg/d or diclofenac 75 mg twice daily for 4 weeks was started. After measurements were obtained, all participants underwent a 2-week washout period and crossed over to the other drug for 4 weeks. A significant difference in mean 24-hour systolic blood pressure was noted between groups at 4 weeks (+4.1+/-1.1 mm Hg diclofenac versus +0.6+/-0.6 mm Hg celecoxib; P=0.01). However, because celecoxib has duration of action shorter than 24 hours, we compared ambulatory values at celecoxib trough and peak activities. At peak, no difference in systolic blood pressure was noted between agents (+3.6+/-0.04 mm Hg diclofenac versus +4.2+/-1.9 mm Hg celecoxib; P=0.67). GFR was also differentially affected at 24 hours (-9.9+/-2.4 mL/min diclofenac versus -0.4+/-1.2 mL/min celecoxib; P=0.01). We conclude that diclofenac and celecoxib increase systolic blood pressure at peak levels; however, these agents differ in their 24-hour effects. Differences observed in blood pressure response between COX inhibitors may not be related in their sensitivity but rather their dosing frequency.
Munavvar Izhar; Tunji Alausa; Amy Folker; Elena Hung; George L Bakris
Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial     Date:  2004-01-26
Journal Detail:
Title:  Hypertension     Volume:  43     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-02-27     Completed Date:  2004-05-24     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  573-7     Citation Subset:  IM    
Rush Medical Center, 1700 W. Van Buren St, Suite 470, Chicago, IL 60612, USA.
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MeSH Terms
African Continental Ancestry Group*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / pharmacology,  therapeutic use
Antihypertensive Agents / therapeutic use
Blood Pressure / drug effects*
Blood Pressure Monitoring, Ambulatory
Cross-Over Studies
Cyclooxygenase 2
Cyclooxygenase 2 Inhibitors
Cyclooxygenase Inhibitors / pharmacology*,  therapeutic use
Diclofenac / pharmacology,  therapeutic use
Gastrointestinal Tract / drug effects
Glomerular Filtration Rate / drug effects
Hispanic Americans*
Hypertension / complications,  drug therapy,  ethnology
Isoenzymes / antagonists & inhibitors
Kidney / drug effects*,  physiopathology
Membrane Proteins
Middle Aged
Osteoarthritis / complications,  drug therapy,  ethnology
Prostaglandin-Endoperoxide Synthases
Sulfonamides / pharmacology,  therapeutic use
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antihypertensive Agents; 0/Cyclooxygenase 2 Inhibitors; 0/Cyclooxygenase Inhibitors; 0/Isoenzymes; 0/Membrane Proteins; 0/Pyrazoles; 0/Sulfonamides; 15307-86-5/Diclofenac; 169590-42-5/celecoxib; EC 2; EC protein, human; EC Synthases

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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