Ibuprofen associated with elevated blood pressure in patients with arthritis
medwireNews: Patients with osteoarthritis (OA) or rheumatoid arthritis (RA) who take ibuprofen are more likely to experience an increase in systolic blood pressure (SBP) than those taking celecoxib, results of the PRECISION-ABPM study suggest.
Given “the established continuous relationship between BP and both cardiovascular and cerebrovascular events,” these findings “could impact clinical outcomes for patients chronically using NSAIDs [non-steroidal anti-inflammatory drugs],” say Frank Ruschitzka (University Hospital Zurich, Switzerland) and fellow researchers.
The study results were presented at the European Society of Cardiology conference in Barcelona, Spain, and published simultaneously in the European Heart Journal.
Ruschitzka and team compared BP changes among 444 patients who already had or were at risk for coronary artery disease and were randomly assigned to receive the NSAIDs ibuprofen or naproxen versus the selective cyclooxygenase (COX)-2 inhibitor celecoxib in the PRECISION trial. The majority (92%) of patients had a diagnosis of OA, and the remaining 8% had RA.
The 151 participants receiving ibuprofen who completed the PRECISION-ABPM substudy experienced an increase in average 24-hour ambulatory SBP from 125.24 mmHg at baseline to 128.65 mmHg at month 4, whereas the 147 in the naproxen group experienced a smaller increase from 123.55 mmHg to 125.46 mmHg. By contrast, the 146 patients receiving celecoxib experienced a decrease in mean SBP from 124.18 mmHg at baseline to 124.00 mmHg at month 4.
These results translated into a significant 3.9 mmHg difference among participants receiving ibuprofen versus those receiving celecoxib, and nonsignificant differences for patients receiving ibuprofen versus naproxen and celecoxib versus naproxen.
Moreover, average 24-hour mean arterial BP at month 4 was increased among participants receiving ibuprofen, but not among those in the celecoxib or naproxen groups. And a significantly higher proportion of patients in the ibuprofen and naproxen groups who did not have elevated BP at baseline developed hypertension over the study period compared with those in the celecoxib group.
Of note, pain control was comparable for participants in the three groups, with average reductions in visual analog scale for pain scores from baseline of 9.4, 12.4, and 7.9 points over the study period for patients in the ibuprofen, celecoxib, and naproxen groups, respectively.
“The findings of PRECISION-ABPM concur with the primary outcome results of the overall PRECISION trial that showed that ibuprofen-treated patients, compared with those who received naproxen and celecoxib, experienced numerically more cardiovascular and renal events,” write the researchers.
“Given the widespread use of NSAIDs, even a small rise in SBP among hypertensive patients with osteoarthritis could substantially increase cardiovascular events in a population,” they add.
Ruschitzka told the press that the team’s findings challenge “the widely advocated belief that conventional NSAIDs, like naproxen and ibuprofen, with their higher COX-1 (and thromboxane reducing) effects would provide greater cardiovascular safety than other more COX-2 selective agents, particularly celecoxib.”
And he added: “Patients should continue to consult their doctor before taking NSAIDs or [COX-2 inhibitors] and clinicians need to weigh the potential hazards of worsening blood pressure control when considering the use of these agents.”
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