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a blood pressure monitor imageSeptember 4 2017

Ibuprofen is associated with increased blood pressure and hypertension compared to celecoxib in patients with osteoarthritis or rheumatoid arthritis, a study has found. It is also associated with an increased risk of cardiovascular disease.

 The findings are from the US-based PRECISION-ABPM study, which was designed to determine the blood pressure effects of the selective cyclooxygenase-2 (COX-2) inhibitor celecoxib compared to the non-selective NSAIDs naproxen and ibuprofen. It involved 444 patients, of whom 408 (92%) had osteoarthritis and 36 (8%) had rheumatoid arthritis. All patients had evidence of, or were at increased risk for, coronary artery disease.

Patients were randomised to receive celecoxib (100-200 mg twice a day), ibuprofen (600-800 mg three times a day), or naproxen (375-500 mg twice a day) with matching placebos. The primary endpoint was the change from baseline in 24-hour ambulatory blood pressure after four months.

Celecoxib decreased the average systolic blood pressure measured over 24 hours by -0.3 mmHg while ibuprofen and naproxen increased it by 3.7 and 1.6 mmHg, respectively. The resulting difference of -3.9 mmHg between celecoxib and ibuprofen was significant (p=0.009).

The results were presented at the European Society of Cardiology meeting. Principal investigator Prof Frank Ruschitzka, professor of cardiology and co-head, Department of Cardiology, University Heart Centre, Zurich, Switzerland, said: While celecoxib and naproxen produced either a slight decrease (celecoxib) or a relatively small increase (naproxen) in blood pressure, ibuprofen was associated with a significant increase in ambulatory systolic blood pressure of more than 3 mmHg.”

In addition, “patients receiving ibuprofen had a 61% higher incidence of de novo hypertension compared to those receiving celecoxib.

“PRECISION-ABPM clearly demonstrates that NSAIDs, particularly ibuprofen, may be not as safe as previously thought … since decreasing systolic blood pressure by just 2 mmHg lowers stroke mortality by 10% and ischaemic heart disease mortality by 7%, increases in systolic blood pressure associated with NSAIDs as observed in PRECISION-ABPM should be considered clinically relevant.”

John Smith, Chief Executive of the branded OTC medicines trade body, the PAGB, pointed out that the study involved patients prescribed high daily doses of NSAIDs to treat the painful symptoms of long term conditions, osteoarthritis and rheumatoid arthritis. “The research outlines that all of the patients in the study already had an increased risk for coronary artery disease, which could have influenced the findings.

“Within this study, the dose of ibuprofen taken was between 600-800mg, three times a day, which is significantly higher than the dose recommended for over-the-counter (OTC) short-term use. NSAIDs that are available to buy OTC are much lower doses than those prescribed and NHS Choices advises adults to take no more than 1,200mg of ibuprofen a day.

“People taking OTC NSAIDs should not be concerned by this research if they are taking the medicine occasionally for short periods and according to the on-pack instructions.

“It is important for people with a history of high blood pressure, heart disease or other long term conditions to speak to a pharmacist before taking any OTC medicine to check for any potential drug interactions or health concerns.”

The study was funded by Pfizer.

Links:
ESC announcement         
PAGB comment                

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