Document Detail

Factors associated with blood pressure changes in patients receiving diclofenac or etoricoxib: results from the MEDAL study.
MedLine Citation:
PMID:  19516186     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the hypertensive effects of etoricoxib and diclofenac relative to baseline hypertension risk factors in arthritis patients. METHODS: Multivariate analysis of data from the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) study (n = 23 504). We evaluated risk factors for change in systolic blood pressure (BP) (SBP) and diastolic BP (DBP) at 4 months versus baseline; exceeding predefined limits of change (PLoC) in BP anytime during the study; and the effect of concomitant antihypertensive class on SBP and exceeding SBP PLoC. RESULTS: Increased SBP was most highly associated with history of hypertension (+3.04 mmHg; P < 0.0001), as were increased DBP (+1.28 mmHg; P < 0.0001), and exceeding DBP PLoC [odds ratio (OR) = 1.83; P < 0.0001]. Exceeding SBP PLoC (OR = 1.50; P < 0.0001) was most highly associated with age at least 65 years. Etoricoxib (vs. diclofenac) was also significantly associated with increased SBP (P < 0.0001), DPB (P < 0.0001 to P = 0.0015), and exceeding SBP PLoC (P < 0.0001 to P = 0.002). Compared with no antihypertensive medication, background calcium channel blockers (CCB) were associated with a small, nonsignificant decrease in SBP (-0.60 mmHg) and no increased odds of exceeding SBP PLoC [OR = 1.00 (95% CI 0.71, 1.42)]. All other antihypertensive classes were associated with either no change or numerically or statistically significantly increased SBP and increased odds of exceeding PLoC. CONCLUSION: History of hypertension and age at least 65 years were most strongly associated with increased BP. Treatment with etoricoxib vs. diclofenac was also a significant factor for increased BP. CCBs appear to maintain antihypertensive effects with concurrent NSAID therapy better than other examined antihypertensive drug classes.
Henry Krum; Gary Swergold; Sean P Curtis; Amarjot Kaur; Hongwei Wang; Steven S Smugar; Matthew R Weir; Loren Laine; D Craig Brater; Christopher P Cannon
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hypertension     Volume:  27     ISSN:  1473-5598     ISO Abbreviation:  J. Hypertens.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-06-11     Completed Date:  2009-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  886-93     Citation Subset:  IM    
Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
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MeSH Terms
Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
Arthritis, Rheumatoid / drug therapy*,  physiopathology
Blood Pressure / drug effects*
Cyclooxygenase 2 Inhibitors / adverse effects*
Diclofenac / adverse effects*
Hypertension / chemically induced
Middle Aged
Multivariate Analysis
Osteoarthritis / drug therapy*,  physiopathology
Pyridines / adverse effects*
Sulfones / adverse effects*
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Cyclooxygenase 2 Inhibitors; 0/Pyridines; 0/Sulfones; 15307-86-5/Diclofenac; 202409-33-4/etoricoxib

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

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