White William B, Kent Jeffrey, Taylor Addison, Verburg Kenneth M, Lefkowith James B, Whelton Andrew
Section of Hypertension and Clinical Pharmacology, University of Connecticut School of Medicine, Farmington, CT 06030-3940, USA.
Hypertension. 2002 Apr;39(4):929-34. doi: 10.1161/01.hyp.0000014323.99765.16.
Nonselective nonsteroidal anti-inflammatory agents have been shown to attenuate the antihypertensive efficacy of ACE inhibitors with average increases in systolic blood pressure (BP) of 5 to 10 mm Hg. Less is known about the specific cyclooxygenase-2 (COX-2) inhibitors now widely used for the treatment of arthritis. The objective of this study was to determine the effects of celecoxib compared with placebo on 24-hour BP levels in ACE inhibitor-treated patients with hypertension. This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial involving 178 men and women (mean age, 53 years) with essential hypertension who were treated and controlled with lisinopril monotherapy (10 to 40 mg daily). Baseline BP values were obtained using 24-hour ambulatory recordings. Patients received either celecoxib, 200 mg twice daily (twice the recommended dose for osteoarthritis) (n=91), or placebo (n=87) for 4 weeks, and changes in the 24-hour BP, body weight, and clinical laboratory parameters were assessed. Mean changes from baseline in the 24-hour systolic and diastolic BP were 2.6/1.5+/-0.9/0.6 mm Hg on celecoxib versus 1.0/0.3+/-1/0.6 mm Hg on placebo (P=0.34 for systolic BP; P=0.45 for diastolic BP). The proportion of patients whose 24-hour BP increased by at least 5, 10, 15, or 20 mm Hg were also similar on celecoxib and placebo. No changes in body weight, serum creatinine, or potassium occurred in either group. Thus, these data demonstrate that high doses of celecoxib have no significant effect on the antihypertensive effect of the ACE inhibitor lisinopril. The placebo-subtracted changes observed in 24-hour BP (1.6/1.2 mm Hg) are less than what has been reported for nonselective nonsteroidal anti-inflammatory agents in ACE inhibitor-treated patients.
非选择性非甾体抗炎药已被证明会减弱血管紧张素转换酶（ACE）抑制剂的降压效果，收缩压（BP）平均升高5至10毫米汞柱。对于目前广泛用于治疗关节炎的特异性环氧化酶-2（COX-2）抑制剂，人们了解较少。本研究的目的是确定在接受ACE抑制剂治疗的高血压患者中，塞来昔布与安慰剂相比对24小时血压水平的影响。这是一项随机、双盲、安慰剂对照、平行组临床试验，涉及178名患有原发性高血压的男性和女性（平均年龄53岁），他们接受赖诺普利单药治疗（每日10至40毫克）并得到控制。使用24小时动态血压记录获得基线血压值。患者接受塞来昔布（每日两次，每次200毫克，为骨关节炎推荐剂量的两倍）（n = 91）或安慰剂（n = 87）治疗4周，并评估24小时血压、体重和临床实验室参数的变化。塞来昔布组24小时收缩压和舒张压较基线的平均变化为2.6/1.5±0.9/0.6毫米汞柱，而安慰剂组为1.0/0.3±1/0.6毫米汞柱（收缩压P = 0.34；舒张压P = 0.45）。24小时血压至少升高5、10、15或20毫米汞柱的患者比例在塞来昔布组和安慰剂组中也相似。两组患者的体重、血清肌酐或钾均无变化。因此，这些数据表明，高剂量塞来昔布对ACE抑制剂赖诺普利的降压效果无显著影响。24小时血压观察到的安慰剂减去后的变化（1.6/1.2毫米汞柱）小于在接受ACE抑制剂治疗的患者中使用非选择性非甾体抗炎药所报告的变化。
